THE HIGH DEPENDENCY UNIT –A PARADIGM FOR IMPROVED OUTCOME

Abstract

Objective: To evaluate indications for obstetric HDU admission, clinical profile, investigations and interventions, length of stay, ICU transfer, and maternal–perinatal outcomes, thereby appraising the utility of HDU care.

Materials and Methods: In a prospective observational study, all booked or referred obstetric patients (including up to 6 weeks postpartum) admitted to the obstetric HDU from August 2018 to July 2019 were enrolled. A pretested proforma captured demographics, obstetric/medical history, indications for HDU admission, interventions, and outcomes. Records of antenatal and puerperal patients were reviewed; obstetric versus medical complications and maternal–fetal outcomes were tabulated and analyzed.

Results: Women with coexisting medical disorders required HDU admission or delivery at earlier gestations than those with obstetric complications alone and presented with greater hemodynamic instability. They needed more aggressive resuscitation, more invasive monitoring, and had longer mean and more frequently prolonged HDU stays. Referred patients also arrived in poorer condition and required more intensive interventions than booked patients, although not all between-group differences reached statistical significance. Overall ICU transfer was low, and maternal mortality was near-negligible.

Conclusion: The clinical severity at presentation, the need for advanced monitoring and interventions, and the observed outcomes indicate that these patients could not be safely managed in a general ward. An obstetric HDU provides effective, intermediate-level care that reduces pressure on the ICU without compromising maternal or fetal outcomes. Where NICU admission is unnecessary, HDU care also supports mother–infant rooming-in, facilitating early breastfeeding and bonding while minimizing separation-related distress.