An examination of obstetric cases admitted to the intensive care unit

Introduction

Most obstetric patients are young and in good health1. However, despite recent therapeutic improvements, maternal mortality and morbidity still happen, and the possibility of fatal consequences exists. This might be brought on by the pregnancy itself, a deterioration of a current condition, or difficulties with an operation. Obstetric patients who are critically unwell present a challenge to intensive care unit (ICU) doctors. Obstetric patients make up only a small percentage (0.1–0.9%) (2,3) of ICU admissions in wealthy countries, whereas this number jumps to 8.5% in poor nations. In most of these cases, the maternal mortality ratio is also greater.developing nations Morbidity rates in developed nations range from 0.05 to 1.7%.

It ranges from 0.6 to 8.5% in nations with little resources.In the industrialised world, a number of scoring systems have been employed to predict the fate of obstetric patients, including the Glasgow Coma Scale (GCS), the Mortality Probability Model (MPM), and the Acute Physiology and Chronic Health Evaluation (APACHE).(4)However, ICU patients from the Indian subcontinent hardly ever took part in these studies because dedicated ICUs are not available in developing nations(5,6). As a result, the current study was carried out to assess obstetric ICU admissions in tertiary referral hospitals with certain resource restrictions, in an effort to identify the risk factors influencing these admissions. Aim and Purpose To determine the maternal outcome in terms of morbidity and death, as well as the risk factors responsible for complications that result in ICU hospitalisation.

MATERIAL AND TECHNIQUES The current review was embraced in the division of Obstetrics and Gynecology Government Clinical School, Nagpur from first July 2012 to 30 June 2013. It was a review observational review. Consent from mmorals board had been taken. Concentrate on populace comprises of 170 obstetric cases conceded in ICU. The aggregate quantities of conveyances during this period were 10923.Test size was determined with reference by review BALOCH R et al.,(6) study and with the understanding that extent of subjects having hypertensive turmoil of pregnancy are 36.2%. (Relative precision=20%,certainty level=95%). Consideration rules: All obstetric patients conceded in ICU The information recovered for investigation contained age, equality,gestational age, booking status, area of home, mode of conveyance, sign for ICU affirmation, mediation in ICU, length of ICU stay and result.

The foundations for admission to ICU were named obstetric and NonObstetric. These patients were followed till released from emergency clinic or till death which at any point happen first. Statistic review Categorical data were given as percentages and continuous data as means and standard deviations. Software called Epi info 3.4.3 was used to examine the data. Using the chi square test, categorical variables were compared. P 0.05 was considered significant. Conclusion This study underlines the extraordinary attributes of basically sick obstetric patients Obstetric drain, hypertensive issues of pregnancy and tropical illnesses like malarial fever, Dengue fever, pig influenza, viral hepatitis and so forth were most normal purposes behind ICU confirmations.

There is change in pattern in reason for maternal mortality as contrasted with different investigations as tropical illnesses arise as driving reason for mortality among Non-Obstetric bunch. The affirmation rate to emergency unit issues looked by fundamentally sick parturient might be decreased by working on antenatal consideration through updating fringe wellbeing focuses, making them exceptional,furnishing them with prepared staff and refreshing their information by leading CMEs through telemedicine, so as to work with early recognizable proof of high gamble pregnancies also, their convenient reference to higher focuses. This will help in diminishing the dreariness and mortality related with hypertensive illnesses in pregnancy and obstetric drain. It is of basic significance to make a connection between obstetric division and ICU focuses to early accomplish distinguishing proof of crediting factors prompting mortality in request to accomplish best forecast.

Doctor in the concentrated consideration ought to be know all about the inconveniences of pregnancy and ought to work intimately with obstetrician to work on maternal result inthese patients.Early affirmation and the board of basically sick obstetric patients in ICU will diminish maternal dismalness and mortality. At long last an exceptional obstetric ICU is expected to manage fundamentally sick obstetric patients as it were. We think this will further develop maternal medical services and this too related with legitimate and productive antenatal consideration, to forestall maternal grimness and mortality. In specific focuses worried about administration of obstetric patients.

References

1. Leung.N.YW, Lau.A.CW, Chan.K.KC & Yan.WW.Clinical characteristics and outcomes of obstetric patients admitted to the Intensive Care Unit: A 10-year retrospective review. Hong Kong Med J 2010;16:18-25.
2. Karnad DR, Lapsia V, Krishnan A, Salvi VS. Prognostic factors in obstetric patients admitted to an Indian intensive care unit. Crit Care Med 2004;32:1294-9.
3. El-Solh AA, Gran BJ. A comparison of severity of illness scoring systems for critically ill obstetric patients. Chest. 1996;110:1299–304.
4. Osinaike B, Amanor-Boadu S, Sanusi A. Obstetric intensive care: A developing country experience.Internet J Anesthesiol. 2006;Vol. 10.
5. Tempe A, Wadhwa L, Gupta S, Bansal S, Satyanarayana L. Prediction of mortality and morbidity by Simplified Acute Physiology Score (SAPS II) in obstetric intensive care unit admissions.Indian J Med Sci. 2007;61:179– 85.
6. Baloch.R, Jakhrani.N.K, Zeb. E, Hafeez. S, Abassi. M &Abbasi.F.N. Pattern And Outcome Of Obstetric Admissions To The Surgical Intensive Care Unit – A Ten Years Study. Journal of Surgery Pakistan (International). October- December 2010; 15 (4):171-176.
7. Kilpatrick SJ, Matthay MA. Obstetric patients requiring critical care. Chest 1992;101:1407-12.
8. Gupta.S, Naithani.U, Doshi.V, Bhargava. V andVijay.B.S. Obstetric critical care: A prospective analysis of clinical characteristics, predictability, and fetomaternal outcome in a new dedicated obstetric intensive care unit. Indian J Anaesth. 2011 Mar-Apr; 55(2): 146–153.
9. Ghike. S and Asegaonkar.P. why obstetric patients are admitted to intensive care unit? A retrospective study.J South Asian FederObstGynae. 2012; 4(2):90-92.
10. Mowafy.A.Hand Mashhour.K.S. Clinical Characteristics and Outcomes of Obstetric Patients Requiring ICU Admission. Med. J. Cairo Univ.2010;Vol. 78, No. 2: 835- 844.
11. Shaikh.S, NajmaBanoShaikh.N.B, Abassi.R &Balouch.R. Obstetric Admission toThe Intensive Care Unit: A One Year Review. MC; 2013: Vol. 19-No.3 (59-63).
12. Bajwa S K, Bajwa S J S,Kaur J, K,2 and Kaur J.Is intensive care the only answer for high risk pregnancies in developing nations?J Emerg Trauma Shock. 2010 Oct- Dec; 3(4): 331–336.
13. Bibi S, Memon A, Sheikh JM and Qureshi AH. Severe Acute Maternal Morbidity and Intensive Care inA Public Sector University Hospital Of Pakistan. J Ayub Med Coll Abbottabad 2008;20(1):109-112.
14. Bhat R, Navada MH, Rao SV and Nagnatha G. Evaluation of obstetric admission to intensive care unit of tertiary care centre in coastal area. Indian J. Crit. Med.2013;17(1):34-37.
15. Devabhaktuni P, Samavedam S, Thota G V S, Pusala S V, Velaga K, Bommakanti L, Nawinne M and Thomas P. Clinical profile and outcome of obstetric ICU patients. APACHE II, SOFA, SAPS II and MPM scoring systems for prediction of prognosis.OJOG.November 2013; Vol.3 No.9
16. Sharma S, Sharma S,Garg S,Taneja A and Puri S.Course and Outcome of Critically ill Obstetric Patients in the ICUs of aTertiary Care Hospital in North India. Indian J. Matern. Child Health.2010; 12(1): 1-11
17. Zwart.J J, Dupuis. J, Richters A, Ory.F &Roosmalen.J.V. Obstetric intensive care unit admission: a 2-year nationwide population-based cohort study. Intensive Care Med; (2010). 36:256–263.
18. Togal.T,Yucel.N,Gedik.E,Gulhas.N,Toprak.H.I&Ersoy.M.O. Obstetric admissions to the intensive care unit in a tertiary referral hospital. J. Crit. Care.2010; 25: 628–633
19. Vasquez DN, Estenssoro E, Canales HS, et al.,Clinical characteristics and outcomes of obstetric patients requiring ICU admission. Chest 2007;131:718-24.

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