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Pregnancy related admissions to high dependency unit-clinical characteristics & outcome

Introduction Critical care in obstetrics has received much attention in recent times. Despite progress in medical field and improvement in health facilities provided, maternal mortality is still very high in most of the developing countries. A critically ill obstetric patient usually recovers rapidly after delivery resulting in a short length of stay with a reduced number of specific interventions in Intensive care unit (ICU) and a good overall prognosis . These patients may require frequent monitoring of vital signs and/or interventions . Hence, it was contemplated about the possible management of these patients in High Dependency Unit . High dependency Unit (HDU) has been proposed as a more appropriate means of resource utilization for these patients. Aims and Objectives To study the indications for admission, interventions required and the outcome of the women’s stay in HDU, in terms of morbidity. Material and Methods The present study is a prospective observational study done over a period of one year in tertiary care hospital. Total of 60 cases with high risk pregnancy admitted in HDU, were included in present study after satisfying inclusion and exclusion criteria. Indications for admission to HDU, interventions required and outcome were studied. Results A study of 60 obstetric patients admitted to HDU in delivery suite was conducted. In present study, the most common indication for admission to HDU was severe preeclampsia, accounting for 21.7% of the admissions. The next common indication was cardiac disease, accounting for 15% of admissions. HELLP accounted for about 13%, PPH for 11% and coagulopathy for 10% of the admissions. In the present study, 33% of patients received about 3-5 blood transfusions and 21% received more than 5 blood transfusions. Majority of the patients (72%) admitted to HDU required oxygen administration and about 70% of the patients received medical intervention in the form of antihypertensives /anticonvulsants / anticoagulants/diuretics and Digoxin. In the present study, majority of the cases (95%) admitted to HDU were transferred out to wards. Only about 5% of them were shifted to I.C.U and all of them required ventilatory support. Conclusion Most of the obstetric complications needing critical care could be managed in HDU with the expert obstetric care. The need for mechanical ventilation became the major indication for maternal ICU admission with an increasing number of patients with haemodynamic instability being managed within the HDU. The antenatal patients also benefit from combined obstetric and critical care management. HDU also provides a multi-disciplinary care from all the specialities and the cost saving is considerable as compared to ICU.