Analysis of obstetric admission patterns and management in the critical care unit, Kenyatta national hospital

Abstract

Background. Pregnancy, delivery and peuperium can be complicated by severe maternal morbidity necessitating CCU admission. Management of the critically ill obstetric patient is very complex due to the physiological changes that occur during pregnancy and presence of the foetus, hence requires co-operation of both the obstetrician and intensivist/anesthetist. The care of critically ill pregnant women requires knowledge not only of the primary disease process and its treatment in the non-pregnant women, but also a thorough understanding of the changes that the maternal peri-partum physiology requires of such care. Critically ill obstetric patients can be managed successfully in the CCU with obstetrician‟s input. Objective. This study is aimed at evaluating the primary causes of CCU admission for expectant mothers, presence of other co-morbid illnesses, system or organ failure, their management and outcomes. The study will also evaluate demographic details such as age, parity, stage of pregnancy and level of education. Methodology. The studywas a prospective, observational study, of all the expectant mothers and those in peri- partum period admitted in KNH CCU. Eligible patients, next of kin or their guardians filled a consent form before being recruited in the study. Sampling was via convenient sampling technique. Parametric and non-parametric information was collected using a data collection tool with details obtained both from the patient‟s medical records and questions asked to next of kin or guardian. Results Total of 50 patients were sampled, and the mean age was 27.6 years, with a range of 17 – 42 years. The duration of stay was less than one week, for majority (66%) of the patients. The main causes of CCU admissions were respiratory distress, low GCS, hypotension and post- cardiac arrest. The leading diagnosis however, were Preeclampsia toxemia, Anemia and Sepsis. The organ system involvement was mostly respiratory(80%), CVS(46%), CNS(56%) and GUT(34%). Majority (68%)of the patients, were referrals from other hospitals.