Integrating acute pain management protocols in obstetric intensive care: the effect on maternal morbidity in eclampsia and HELLP syndrome

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Abstract
Background & objective: Eclampsia and HELLP syndrome are serious hypertensive diseases of pregnancy that are frequently admitted to the ICU. When it comes to seizure control and hypertension control, standardization of protocols in pain management is well established, although these are not commonly used; yet there is evidence that connects pain and adverse maternal outcomes. This systematic review and meta-analysis were used to assess the effectiveness of acute pain management protocols in reducing the maternal morbidity and other clinical outcomes in pregnant women admitted to the ICU for eclampsia or HELLP syndrome. Methods: This systematic review and meta-analysis was conducted according to PRISMA 2020 guidelines. A systematic search was pursued in [PubMed], Scopus, Web of Science, and Cochrane databases for the studies produced till 2025. Inclusion criteria included RCTs, observational, and case report studies that focused on pain protocols in the obstetric ICUs. The key outcomes were maternal morbidity, ICU stay duration, and maternal-fetal survival. Assessment of risk of bias was done using the Newcastle-Ottawa Scale and Cochrane RoB tool. A random effect model of meta-analysis was used. Results: 12 studies with 10, 153 patients were selected. Protocolized pain management, such as opioid- sparing and regional anesthesia, lowered the rate of maternal complications and stay in the ICU. The pooled OR for the better maternal outcomes was 1.23 (95% CI: 0.86–1.75), though not statistically significant. There was substantial heterogeneity (I² = 77%, p < 0.01), which was explained by protocol variation and disease severity variation. Conclusion: Incorporating the structured pain management protocols in the obstetric ICU care for eclampsia and HELLP syndrome can ameliorate the maternal outcomes, but the current evidence is heterogeneous. Regarding the necessity of RCTs, further multicenter RCTs are needed to standardize pain protocols in the high-risk population. Keywords: HELLP Syndrome; Anesthesia; Maternal Outcomes; Obstetric Complications; Meta-Analysis Citation: Bibi F, Chaudhry S, Riaz H, Gul E, Yasmeen R, Ramzan H, Khaliq H. Integrating acute pain protocols in obstetric intensive care: the effect on maternal morbidity in eclampsia and HELLP syndrome. Anaesth. pain intensive care 2025;29(4):326-33. DOI: 10.35975/apic.v29i4.2817 Received: May 09, 2024; Revised: October 26, 2024; Accepted: January 01, 2025

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