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


METHODS
Retrospective study.


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


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


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.
Munnur
Uma
U
Department of Anesthesiology and Obstetrics, Baylor College of Medicine, Ben Taub General Hospital, Houston, TX, USA.
Karnad
Dilip R
DR
Bandi
Venkata D P
VD
Lapsia
Vijay
V
Suresh
Maya S
MS
Ramshesh
Priya
P
Gardner
Michael A
MA
Longmire
Stephen
S
Guntupalli
Kalpalatha K
KK
D000328:Adult; D003422:Critical Care / Q000191:economics; D016638:Critical Illness; D005260:Female; D005865:Gestational Age; D006779:Hospitals, Public; D006801:Humans; D007194:India; D007362:Intensive Care Units; D009102:Multiple Organ Failure / Q000209:etiology / Q000628:therapy; D011247:Pregnancy; D011248:Pregnancy Complications / Q000145:classification / Q000175:diagnosis / Q000628:therapy*; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000209:etiology / Q000628:therapy; D016896:Treatment Outcome; D014481:United States