Severe acute maternal morbidity and intensive care in a public sector university hospital of Pakistan.

BACKGROUND The study was planned to review the case series of pregnant women requiring intensive care due to severe acute maternal morbidity in the public sector university hospital, in order to identify failures and priorities in maternal health care provision in Pakistan. METHODS A retrospective case series study was performed of critically ill obstetrics patients admitted to general intensive care unit of Liaquat University Hospital Hyderabad, Pakistan, from January 1st to 31st December 2006. Data included demographics, disease responsible for critical illness, complications that prompted ICU admissions, intervention required, length of ICU stay and the resulting foeto-maternal mortality and morbidity. RESULTS Over the study period, 30 obstetric patients were transferred to general ICU, representing 1.34% of 2224 deliveries. Seventy three % of women belonged to rural areas, 96% were un-booked while history of surgical intervention was present in 87% of cases. Hypertensive disorders of pregnancy (50%) and sepsis (17%) were the two main obstetrical conditions responsible for maternal illness. Respiratory failure (57%) and haemodynamic instability (40%) were the major indications for ICU transfer. Mechanical ventilatory support was the commonest intervention required in the ICU followed by the ionotropic support (33%). The foetal mortality rate was 43%, while maternal mortality rate was 33%. CONCLUSION Maternal morbidity and mortality can be reduced by meticulous adaptation of safe motherhood initiative, provision of separate ICU services for critically ill obstetrical patients and early assessment and aggressive intervention through a team approach involving obstetricians, intensivists and anaesthetists.