Clinical profile and outcome of obstetric ICU patients. APACHE II, SOFA, SAPS II and MPM scoring systems for prediction of prognosis

Abstract

Objectives: To evaluate the various scoring systems, APACHE II, SOFA, SAPS II and MPM for the pre-diction of prognosis of the obstetric critically ill pa-tients admitted in a well supported ICU unit. Mate-rial and methods: A prospective, observational study was conducted among all the obstetric patients ad-mitted to the ICU between October 2011 and Decem-ber 2012, during a period of 15 months. The data col-lected were of three categories: demographic, obstet-ric and ICU related. Results and Analysis: The pa-tients admitted in the postpartum period (n = 28, 53.84%) were more than the antenatal admissions (n = 24, 46.16%). 32.69% of admissions were in the third trimester. The most common mode of delivery was emergency caesarean section (n = 27/40, 67.5%). Total caesarean deliveries were 35/40 = 87.5% in ICU patients. The mortality prediction scores were calcu-lated for 41 patients only as acid blood gas analysis was not available for the rest. Patients required ven-tilation—51.92%, hemodialysis—19.23%, inotropic sup-port—38.46%, blood transfusion—50%. Analysis of the statistical data for ICU parameters has shown that hospital stay (p = 0.011) and ventilation days (p = 0.014) are significant predictors of maternal outcome. Age (p = 0.789), ICU stay (p = 0.701) and RRT (p = 0.632) are not significant. Among the obstetric ICU ad-missions, hypertensive disorders of pregnancy (30.76%) was the predominant cause followed by obstetric hae-morrhage (23.07%). Discussion: HELLP syndrome and eclampsia (n = 4, 57%) were the major causes of ma-ternal deaths with anaesthetic mishaps accounting for 29% (n = 2). One (14%) death was due to Eisenmen-ger's syndrome. In one case of H1N1 admitted with ARDS, caesarean section was done in MICU for wor-sening respiratory distress. The maternal mortality in this series of cases was 7/52 = 13.46%, excluding the un-avoidable cases of maternal death (3 cases brain dead at admission and one cardiac arrest in emergency room), our maternal mortality rate is 3/48 = 6.25%. The pre-dicted mortality as measured by all scoring systems (for 41 patients) was between 17% and 30%. The ob-served mortality was around 17%. Hence a reduction in mortality of 40% has been achieved due to intensive care. Conclusions: Leading cause of maternal mortality was HELLP syndrome. Hypertensive disorders of preg-nancy were the most common cause of admission to ICU. In this study, all the scores were equally signifi-cant in predicting maternal mortality. Amongst the in-terventions done for these patients mechanical ventila-tion seems to have an influence on the overall outcome.