Critically ill obstetric patients in an American and an Indian public hospital: comparison of case-mix, organ dysfunction, intensive care requirements, and outcomes
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To compare case-mix, health care practices, and outcome in obstetric ICU admissions in inner-city teaching hospitals in economically developed and developing countries.
Ben Taub General Hospital (BTGH), Houston, Texas, and King Edward Memorial Hospital (KEMH), Mumbai, India.
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.
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.
KeywordsPregnancy Critical illness Puerperium Near-miss maternal mortality Maternal health Developing countries Tropical diseases Antenatal care Intensive care unit
- 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
- 4.Maine D, Chavkin W (2000) Maternal mortality: global similarities and differences. J Am Med Womens Assoc 57:127–130Google Scholar
- 10.World Health Organization (2002) The world health report 2002. World Health Organization, GenevaGoogle Scholar
- 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
- 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
- 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
- 18.Gilstrap LC, Ramin SM (2001) Urinary tract infections during pregnancy. Obstet Gynecol Clin 28:581–591Google Scholar
- 30.Kimber J (2002) Cerebral venous sinus thrombosis. Q J Med 95:137–142Google Scholar
- 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.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