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Intensive Care Medicine

, Volume 31, Issue 8, pp 1087–1094 | Cite as

Critically ill obstetric patients in an American and an Indian public hospital: comparison of case-mix, organ dysfunction, intensive care requirements, and outcomes

  • Uma Munnur
  • Dilip R. Karnad
  • Venkata D. P. Bandi
  • Vijay Lapsia
  • Maya S. Suresh
  • Priya Ramshesh
  • Michael A. Gardner
  • Stephen Longmire
  • Kalpalatha K. Guntupalli
Original

Abstract

Objective

To compare case-mix, health care practices, and outcome in obstetric ICU admissions in inner-city teaching hospitals in economically developed and developing countries.

Design

Retrospective study.

Setting

Ben Taub General Hospital (BTGH), Houston, Texas, and King Edward Memorial Hospital (KEMH), Mumbai, India.

Patients

Women admitted during pregnancy or 6 weeks postpartum between 1992 and 2001.

Measurements and results

Patients from BTGH (n=174) and KEMH (n=754) had comparable age, number of organs affected, incidence of medical disorders (30%), liver dysfunction, and thrombocytopenia. Fewer KEMH patients received prenatal care (27 vs 86%) and came to hospital within 24 h of onset of symptoms (60 vs 90%). They had higher APACHE II scores (median 16 vs 10), greater incidence of neurological (63 vs 36%), renal (50 vs 37%), and cardiovascular dysfunction (39 vs 29%). Severe malaria, viral hepatitis, cerebral venous thrombosis, and poisoning were common medical disorders. The BTGH group had higher incidence of respiratory dysfunction (59 vs 46%) and disseminated intravascular coagulation (40 vs 23%), placental anomalies, HELLP syndrome, chorioamnionitis, peripartum cardiomyopathy, puerperal sepsis, urinary infection, bacteremia, substance abuse, and asthma. More BTGH patients required mechanical ventilation and blood component therapy, whereas more KEMH patients needed dialysis. Of BTGH patients, 78.2% were delivered by cesarean section (vs 15.4%). Maternal (2.3 vs 25%) and fetal (13 vs 51%) mortality were lower in BTGH patients.

Conclusions

There were marked differences in medical diseases, organ failure, and intensive care needs. Higher mortality in the Indian ICU may be due to difference in case mix, inadequate prenatal care, delay in reaching hospital, and greater severity of illness.

Keywords

Pregnancy Critical illness Puerperium Near-miss maternal mortality Maternal health Developing countries Tropical diseases Antenatal care Intensive care unit 

References

  1. 1.
    Collop NA, Sahn SA (1993) Critical illness in pregnancy: analysis of 20 patients admitted to a medical intensive care unit. Chest 103:1545–1552Google Scholar
  2. 2.
    Lapinsky SE, Kruczynski K, Seaward GR, Farne D, Grossman RF (1997) Critical care management of the obstetric patient. Can J Anaesth 44:325–329PubMedGoogle Scholar
  3. 3.
    Afessa B, Green B, Delke D, Koch K (2001) Systemic inflammatory response syndrome, organ failure and outcome in critically ill obstetric patients treated in an ICU. Chest 120:1271–1277CrossRefPubMedGoogle Scholar
  4. 4.
    Maine D, Chavkin W (2000) Maternal mortality: global similarities and differences. J Am Med Womens Assoc 57:127–130Google Scholar
  5. 5.
    Parikh C, Karnad DR (1999) Quality, cost and outcome of intensive care in a public hospital in Bombay, India. Crit Care Med 27:1754–1759CrossRefPubMedGoogle Scholar
  6. 6.
    Bhagwanjee S, Paruk F, Moodley J, Muckart DJJ (2000) Intensive care unit morbidity and mortality from eclampsia: an evaluation of the Acute Physiology and Chronic Health Evaluation II score and the Glasgow Coma Scale score. Crit Care Med 28:120–124CrossRefPubMedGoogle Scholar
  7. 7.
    Tripathi R, Rathore AM, Saran S (2000) Intensive care for critically ill obstetric patients. Int J Gynecol Obstet 68:257–258CrossRefGoogle Scholar
  8. 8.
    Dao B, Rouamba A, Ouedraogo D, Kambou T, Bazie AJ (2003) Transfer of obstetric patients to an intensive care unit: an eighty-two case report in Burkina Faso. Gynecol Obstet Fertil 31:123–126CrossRefPubMedGoogle Scholar
  9. 9.
    Dias de Souza JP, Duarte G, Basile-Filho A (2002) Near-miss maternal mortality in developing countries. Eur J Obstet Gynecol Reprod Biol 104:80CrossRefPubMedGoogle Scholar
  10. 10.
    World Health Organization (2002) The world health report 2002. World Health Organization, GenevaGoogle Scholar
  11. 11.
    Murray CJL, Govindraj R, Musgrove P (1994) National health expenditures: a global analysis. In: Murray CJL, Lopez AD (eds) Global comparative assessments in the health sector: disease burden, expenditure and interventional packages. World Health Organization, Geneva, pp 141–155Google Scholar
  12. 12.
    Fiscella K, Franks P, Gold MR, Clancy C (2002) Inequality in quality: addressing socioeconomic, racial, and ethnic disparities in health care. J Am Med Assoc 283:2579–2584CrossRefGoogle Scholar
  13. 13.
    Texas Department of Health (2001). Bureau of Vital Statistics 2001 Annual Report, Mortality. Accessed 5 April 2003: http://www.tdh.state.tx.us/bvs/stats01/text/01mortal.htmGoogle Scholar
  14. 14.
    McLaughlin DK, Stokes CS (2002) Income inequality and mortality in US counties: Does minority racial concentration matter? Am J Public Health 92:99–104PubMedGoogle Scholar
  15. 15.
    Klineberg SL (2002) Houston’s economic and demographic transformation. Findings from the expanded 2002 survey of Houston’s ethnic communities. Rice University, HoustonGoogle Scholar
  16. 16.
    Marshall JC, Cook DJ, Christou NV, Bernard GR, Sprung CL, Sibbald WJ (1995) Multiple Organ Dysfunction Score: a reliable descriptor of a complex clinical outcome. Crit Care Med 23:1638–1652CrossRefPubMedGoogle Scholar
  17. 17.
    Williams KP, Wilson S (1997) Ethnic variation in the incidence of HELLP syndrome in a hypertensive population. J Perinat Med 25:498–501PubMedGoogle Scholar
  18. 18.
    Gilstrap LC, Ramin SM (2001) Urinary tract infections during pregnancy. Obstet Gynecol Clin 28:581–591Google Scholar
  19. 19.
    Schloes D, Hooton TM, Roberts PL, Stapleton AE, Gupta K, Stamm WE (2000) Risk factors for recurrent urinary tract infection in young women. J Infect Dis 182:1177–1182CrossRefPubMedGoogle Scholar
  20. 20.
    Riley EM, Schneider G, Sambou I, Greenwood BM (1989) Suppression of cell-mediated immune responses to malaria antigens in pregnant Gambian women. Am J Trop Med Hyg 40:141–144PubMedGoogle Scholar
  21. 21.
    Abbrescia K, Sheridan B (2003) Complications of second and third trimester pregnancies. Emerg Med Clin N Am 21:695–710CrossRefGoogle Scholar
  22. 22.
    Krishnan A, Karnad DR (2003) Severe falciparum malaria: an important cause of multiple organ failure in Indian ICU patients. Crit Care Med 31:2278–2284CrossRefPubMedGoogle Scholar
  23. 23.
    Jaiswal SP, Jain AK, Naik G, Soni N, Chitnis DS (2001) Viral hepatitis during pregnancy. Int J Gynaecol Obstet 72:103–108CrossRefPubMedGoogle Scholar
  24. 24.
    Khuroo MS, Kamili S (2003) Aetiology, clinical course and outcome of sporadic acute viral hepatitis in pregnancy. J Viral Hepat 10:61–69CrossRefPubMedGoogle Scholar
  25. 25.
    Cuthbert JA (2001) Hepatitis A: old and new. Clin Microbiol Rev 14:38–58CrossRefPubMedGoogle Scholar
  26. 26.
    Patel V, Rodrigues M, DeSouza N (2002) Gender, poverty, and post-natal depression: A study of mothers in Goa, India. Am J Psychiatry 159:43–47CrossRefPubMedGoogle Scholar
  27. 27.
    Batra AK (2003) Burn mortality: recent trends and sociocultural determinants in rural India. Burns 29:270–275CrossRefPubMedGoogle Scholar
  28. 28.
    Turner RJ, Lloyd DA (2003) Cumulative adversity and drug dependence in young adults: racial/ethnic contrasts. Addiction 98:305–315CrossRefPubMedGoogle Scholar
  29. 29.
    Finley BE (1989) Acute coagulopathy in pregnancy. Med Clin North Am 73:723–743PubMedGoogle Scholar
  30. 30.
    Kimber J (2002) Cerebral venous sinus thrombosis. Q J Med 95:137–142Google Scholar
  31. 31.
    International Institute of Population Sciences (2000) National Family Health Survey 1998–1999 (NFHS-2): Maharashtra (preliminary report). International Institute of Population Sciences, Mumbai, pp 30–32Google Scholar
  32. 32.
    Dildy GA, Phelan JP, Cotton DB (1991) Complications of pregnancy-induced hypertension. In: Clark SL, Cotton DB, Hankins GV, Phelan JP (eds) Critical care obstetrics, 2nd edn. Blackwell, Cambridge, Massachusetts, pp 251–300Google Scholar
  33. 33.
    Norwitz ER, Hsu CD, Repke JT (2002) Acute complications of pre-eclampsia. Clin Obstet Gynecol 45:308–329CrossRefPubMedGoogle Scholar
  34. 34.
    Gibbs RS (1989) Severe infection in pregnancy. Med Clin North Am 73:713–721PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Uma Munnur
    • 1
  • Dilip R. Karnad
    • 2
  • Venkata D. P. Bandi
    • 3
  • Vijay Lapsia
    • 2
  • Maya S. Suresh
    • 1
  • Priya Ramshesh
    • 2
  • Michael A. Gardner
    • 1
  • Stephen Longmire
    • 1
  • Kalpalatha K. Guntupalli
    • 3
  1. 1.Department of Anesthesiology and Obstetrics, Baylor College of MedicineBen Taub General HospitalHoustonUSA
  2. 2.Department of Medicine, Medical-Neuro Intensive Care UnitKing Edward Memorial HospitalParel, Mumbai India
  3. 3.Department Of Medicine, Pulmonary and Critical Care Section, Baylor College of MedicineBen Taub General HospitalHoustonUSA

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