Introduction: Maternal mortality and morbidity are important indicators of the quality of health-care services. Obstetric admissions to an intensive care unit may be considered a marker of maternal morbidity. The aim of this study was to determine the incidence, maternal morbidity and mortality of pregnant and postpartum women who required admission to the intensive care unit.Material and Methods: Retrospective analysis of all the obstetric patients admitted to the intensive care unit between 2000 and 2017. Results: Ninety-three women required admission to intensive care (0.7 per 1000 deliveries, 0.8% of all adult admissions). Mean age was 30.3 years, mean gestational age was 33.6 weeks, 51 (54.8%) were primiparous, nine (9.7%) were pregnant of twins and five (5.4%) had not been followed during pregnancy. Eighty-four (90.3%) were admitted after immediate delivery. The most common reasons for admission were hypertensive disorders of pregnancy (35.5%) and obstetric haemorrhage (24.7%). Median length of stay was five days. Transfusion of blood products was needed in 23 (57.0%), artificial ventilation in 50 (53.8%) and use of vasopressors in 21 (22.6%). We observed four maternal deaths (4.3%). Most patients (95.7%) successfully recovered and were transferred to other departments. Sequential Organ Failure Assessment score was significantly associated with maternal mortality.Discussion: Our results are comparable to those obtained in other studies. Maternal mortality was comparable to maternal mortality in developed countries.Conclusion: The incidence of obstetric admissions to the intensive care unit was 0.8% and 0.7 per 1000 deliveries. Hypertensive disorders of pregnancy were the main causes of admission. Maternal mortality was 4.3%. Studies of maternal morbidity are important and can help to improve the quality of health care services.
Introduction: Safety is essential in all the anesthesiologists’ activity. Anesthesiology pioneered the use of simulation in training. Human factors play a big part in critical incidents. Understanding and identifying key cognitive errors specific to anesthesiology is the first step in metacognition training and strategies to prevent these errors and improve patient safety.
A 64y female patient, ASA III, submitted to emergency laparotomy with right hemicolectomy. Surgery went uneventful until wound closure. After metamizole administration, the patient had had generalized skin rash, hypoxemia, bradycardia and hypotension, treated as an anaphylactic shock. In the recovery room, she had another episode of severe She had cardiac arrest. Advanced life support was successful. Ecofast (acronym for “The Focused Abdominal Sonography for Trauma Scan") revealed intraperitoneal fluid compatible with massive hemoperitoneum. Hemorrhagic shock was treated with exploratory laparotomy and hemodynamic support with progressive improvement.
It is important to note that a possible fixation error could have delayed the diagnosis of the hemorrhagic shock that overlapped the first anaphylactic shock and culminated in cardio-respiratory arrest. Fixation errors occur when one focuses only on one factor rather than other equally relevant and more predictable ones. Training through simulation increases awareness of potential problems in routine and non-routine settings and allows faster skill acquisition and recognition of problems. ACRM programs where the CRM model is applied to anesthesiology, allows the teaching and training of team behaviors in crisis situations.
Citation: Husson N, Carreira C, Babo N. One shock after another; simulation can prevent fixation errors: A case report. Anaesth pain & intensive care 2019;23(4)__
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