Abstract: Poster Presentations |

Critical Care Resource Utilization and Outcomes of Obstetric Patients in an American and an Indian Public Hospital FREE TO VIEW

Uma Munnur, MD; Dilip R. Karnad, MD; Maya S. Suresh, MD; Venkata D. Bandi, MD; Vijay Lapsia, MD; Priya Ramshesh, MD; Kalpalatha K. Guntupalli, MD
Author and Funding Information

Baylor College of Medicine, Houston, TX; King Edward Memorial Hospital, Mumbai, India


Chest. 2003;124(4_MeetingAbstracts):183S-b-184S. doi:10.1378/chest.124.4_MeetingAbstracts.183S-b
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PURPOSE:  To study outcomes of pregnant patients requiring intensive care unit support (ICU) in two public teaching hospitals: Ben Taub General Hospital, Houston, Texas and King Edward Memorial Hospital, Mumbai, India. {Similar hospitals in terms of location (major cities) and type of population served}.

METHODS:  Retrospective chart review of 174 US and 754 Indian pregnant patients admitted to ICUs between 1992 and 2001 was conducted. APACHE II and Multiple Organ Dysfunction Score (MODS) were collected along with outcomes.

RESULTS:  Fewer Indian patients received prenatal care (27% vs. 86%); presented to hospital > 24hrs later (40% vs. 10%), and were sicker (median APACHE II score 16 vs. 10). Indian patients presented predominantly due to seizures and AMS, while US patients with fever, SOB and bleeding. Neurologic (63% vs. 36%), renal (50% vs. 37%) and cardiovascular dysfunction (39% vs. 29%) were more common in Indian patients. Hematologic (63% vs. 56%) and respiratory dysfunction (59% vs. 46%) were more common in US patients. Although the number of organs affected were similar (median 2) in both groups, the maximum MODS was higher in the Indian patients. More US patients required mechanical ventilation and blood products, while more Indian patients received dialysis. Induction of labor, C-section and hysterectomy were more frequently performed in US patients. Pre-eclampsia was the commonest illness in both groups. Among the medical disorders Malaria, viral hepatitis and cerebral venous thrombosis were common in Indian patients, where as bacterial sepsis, drug abuse, asthma and acute abdomen were common in US patients. Indian PatientsUS PatientsIntrauterine fetal demise12.5%4.6%HELLP5.6%17.8%Puerperal sepsis6.5%14.9%Peripartum cardiomyopathy0.5%5.8%Medical disorders30%30%Length of stay days4 (3–5)3 (2–4)Fetal mortality51%13%Maternal mortality25%2.3%CONCLUSIONS: Fetal and maternal mortality were higher in Indian patients, probably due to less prenatal care, late admission, greater severity of illness and differences in health care availability. Although the spectrum of obstetric disorders is similar, medical disorders greatly differed, as did organ involvement and ICU needs.

DISCLOSURE:  U. Munnur, None.

Wednesday, October 29, 2003

12:30 PM - 2:00 PM




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