A study of maternal and fetal outcomes in critically ill obstetric patients
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20201225Keywords:
Critically ill, Ionotropic support, Intensive care unit, Mechanical ventilator, Near missAbstract
Background: Pregnancy related morbidity is becoming a nightmare in Indian women. Some of these women end up in mortality and a few of them narrowly escape death. Critical care should be and is an authenticated part of obstetric practice. This study is an effort initiated to understand the risk of maternal morbidity, to investigate the contributing factors, foetal outcome, to study the adverse event, cause of maternal death and remedial measures.
Methods: All the obstetric cases admitted in Intensive care unit in a government institute in Maharashtra during January 2018 to June 2019 were analyzed prospectively. The indications for transfer into intensive care, risk factors, co morbidities if any were studied. Maternal and fetal morbidity and mortality were included in the study.
Results: During the study period, there were 10, 208 deliveries. There were 12 maternal deaths and 98 critically ill patients became morbid. Anemia is found to be a major pre-existing contributing factor (25.5%) and an important risk factor making pregnancy become critical. DIC is found to be a major reason for ICU admission (39.1%), 72.7% needed mechanical ventilator and 60.1% needed ionotropic support.
Conclusions: Anemia is a major problem still existing in our country. Gestational hypertension is another leading cause of critical illness in pregnancy. Identification of patients who are going downhill, timely referral to higher centers and appropriate management can improve both the maternal and the fetal outcomes.
References
Tasneem F, Shanbhag V. Study of cases of double mishap in a tertiary care teaching hospital. Int J Reprod Contracept Obstet Gynecol. 2019;8:1650-4.
Azima S, Ashrafizaveh A, Gholamzade S, Kaviani M, Mousavi S, Bakhshayesh HR. Causes of maternal and perinatal mortality: a retrospective study. Inter J Curr Microbiol Appl Sci. 2015;4(3):733-9.
AbouZahr C. Global burden of maternal death and disability. Br Med Bull. 2003;67:1-11.
Verma S, Rai L, Kumar P, Pai MV, Shetty J. Near miss, obstetrics event and maternal deaths in a tertiary care hospital: an audit. J Preg. 2013:2013.
Bhadade R. Rosemarie de’ Souza, Anirudha More and Minal Harde, maternal outcomes in critically ill obstetrics patients: a unique challenge. Indian J Critical Care Med. 2012;16(1):8-16.
Sinha M, Goel JK, Sah S, Goel R, Chaurasia R. Severe acute maternal morbidity: study of epidemiology and risk factors. Int J Reprod Contracept Obstet Gynecol. 2016;5:2141-5.
Mustafa R, Hashima H. Near-miss obstetrical events and maternal deaths. J Coll Phys Surg Pak. 2009;19(12)781-5.
Ranatunga G, Akbar J, Samarathunga S, Perera Y, Kariyawasam L, Kumarasiri J. Severe acute maternal morbidity in a tertiary care institute, Sri Lanka. J Obstet Gynecol. 2012;34:135-43.
Sreenivas K, Beevi N, Devi U. Clinical characteristics and outcome of obstetric patients who required mechanical ventilation in a tertiary care hospital in North Kerala. Indian J Clin Pract. 2014;25(6):552-6.
Yellikar KA, Deshpande SS, Deshpande SF. Severe acute maternal morbidity in a tertiary care center with basic intermediate respiratory care unit setup. Int J Sci Stud. 2015;3(5):36-40.
Rakesh HJ, Diana V. Study of prevalence and factors associated with maternal near miss (MNM) cases and maternal death at Rajiv Gandhi Government Women and Children Hospital, Pondicherry, India. Int J Reprod Contracept Obstet Gynecol. 2018;7:1048-53.
Roopa PS, Verma S, Rai L, Kumar P, Pai MV, Shetty J. Research article ‘‘near miss’’ obstetric events and maternal deaths in a tertiary care hospital: an audit, Hindawi Publishing Corporation J Preg. 2013:Article ID 393758.
Mantel GD, Buchmann E, Rees H, Pattinso RC. Severe acute maternal morbidity: a pilot study of a definition for a near-miss. Br J Obstet Gynecol. 1998;105:985-90.
Padmavati P. Critical care in obstetrics: a one year prospective study in a tertiary care hospital. IOSR J Dental Med Sci. 2017:30-43.
Patil V, Kamath V, Desai RM. Obstetric near miss events and maternal deaths in a tertiary care hospital. Int J Reprod Contracept Obstet Gynaecol. 2018;7:519-23.
Appinabhavi A, Panicker S, Rajkumar N. Maternal and perinatal outcomes in critically ill obstetric patients. Int J Reprod Contracept Obstet Gynecol. 2014;3(1):189-94.
