Obstetric critical care in developing countries: a comparison between two intensive care units

Introduction

To describe both characteristics and differences of critically ill obstetric patients in two ICUs from two developing countries.

Methods

A comparative study between two historic cohorts (2001 to 2002 from South Africa and 2006 to 2007 from Colombia) was designed to analyze characteristics from two ICUs in two developing countries: one in South Africa, King Edward VII Hospital (KEH) (South Africa); and another in Colombia, Clínica Maternidad Rafael Calvo (CMRC) (Colombia). Differences between both cohorts were assessed through chi-square and ANOVA. P < 0.05 was considered statistically significant.

Results

There was a high rate of obstetrical admissions in both ICUs. Three hundred and ninety-eight patients were registered during these periods of time: 214 patients were from South Africa, 184 from Colombia. The most frequent diagnosis was hypertensive disorders during pregnancy (KEH = 65.4%, CMRC = 47%; P < 0.001). There were no statistical differences between the two ICUs regarding age, gestational age, ICU stay/days and mechanical ventilation days. There were statistically significant differences in APACHE II score and mortality, being highest in South Africa. All types of organ dysfunctions were lower in CMRC; with statistical significance in cardiovascular, haematologic and neurologic dysfunction. OR from mechanical ventilation was 0.02 (P < 0.001), being lower in CMRC (25.67%). There were no statistical differences in cesarean section and haemodialysis.

Conclusions

Obstetric critical care is considered of special interest in these countries, where 90% of global maternal mortality can be found. Although there are common characteristics regarding admissions of these patients to ICU settings, it is also evident that differences are noted when considering demographics and interventions in obstetric critically ill patients.