Background: Care of the critically ill obstetric patients is a unique challenge particularly because of its unpredictability. The outcome in these patients would not only contribute to the assessment of the quality of patient care but would also enhance the risk stratification of pregnant patients in the evaluation of new therapies. This study is intended to review a series of critically ill obstetric patients admitted to our ICU to assess the spectrum of disease, required interventions, and maternal outcome, and to identify conditions associated with maternal death. Methods: This retrospective cohort study was conducted in 16-bed medical and surgical ICU in a 500 bedded tertiary care hospital over a period of 5 years (2009-2013) at Bhubaneswar, Odisha, India. Results: Only 54 obstetric patients were admitted to the ICU which constitutes 2.09% of all ICU admissions, 0.78% of emergency obstetric admissions and 0.9% of the total deliveries. Majority of patients (79.62%) were admitted during postpartum period. The leading obstetric indication for ICU admission was obstetric hemorrhages (29.6%). Ectopic pregnancy was common (7 patients) among the obstetric hemorrhages. In the present study maternal mortality was 16.6%, while 70.3% were improved after treatment. The main cause of maternal death was obstetric haemorrhage (55.5%). ICU interventions during the stay of the patients in terms of mechanical ventilation were used in 72.2% of cases. Other interventions included blood & blood product transfusion in 30 (55.5%), inotropes in 34 (62.9%), antihypertensive in 14 (25.9%), anticonvulsant in 16 (29.6%) & dialysis in 4 (7.4%) cases. Conclusions: The need of ICU management for obstetric conditions is on rising trend. The need for ventilatory or inotropic support may predict poor outcome. An adequate adoption of safe motherhood initiative would reduce obstetric ICU admissions and thereby will also reduce the maternal mortality.

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Maternal mortality is ascribed usually to complications that generally occur during or around labor and cannot be accurately predicted. The direct causes of maternal mortality, that is, hemorrhage, unsafe abortion, eclampsia, obstructed labor, infection, and others account for about three-fourths of maternal deaths. The remaining ABSTRACT Background: Pregnancy, although being considered a physiological state, carries risk of serious maternal morbidity and at times death. This is due to various complications that may occur during pregnancy, labor, or thereafter. The major causes of maternal mortality are mostly preventable through regular antenatal check-up, proper diagnosis, and management of labor complications. Therefore, the factors at different levels affecting the use of these services need to be clearly understood. The aim is to study the incidence of MMR, assess the epidemiological aspects, causes of maternal mortality and avoidable factors that can prevent maternal deaths. Methods: A retrospective hospital-based study was conducted in obstetrics and gynecology department, SLN MCH, a tertiary care referral hospital in a tribal area of southern Odisha over a period of 2 years from April 2017 to March 2019. Results: A total of 108 deaths were analyzed over 2 years period and MMR was calculated to be 1124/1 lakh live births. Most of the maternal deaths occurred in the age group of 20-24 years (35.1%), majority of maternal deaths were observed in multipara (46.3%), 70.3% deaths occurred within 24 hours of admission. Hypertensive disorders in pregnancy (37%) were the leading direct cause followed by hemorrhage (14.8%) and sepsis (11.1%). Among the indirect causes jaundice (7.4%) and anaemia (3.7%) were the leading cause. Conclusions: MMR in our study was very high as compared to national average of 167/1,00,000 live births, being a tertiary care hospital as most of the patients were referred from peripheral centers. Most maternal deaths are preventable by intensive health education, basic obstetric care for all, strengthening referral and communication system and emphasizing on overall safe motherhood.

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INTRODUCTIONHepatitis E virus is a non-envelope RNA virus responsible for large epidemics in Asia, the Middle east Mexico and Africa. It spreads via the feco-oral route, and has an incubation period of 8-10 weeks. The infection is usually self-limited and does not result in chronic disease. The incidence of acute viral hepatitis E is identical in pregnant and non-pregnant persons. However, pregnant women are at high risk for acute and fulminant hepatitis. Mortality rate in pregnancy can reach 25% whereas it is 0.65% non-pregnant women.1 HEV infection occurs in the late stages of pregnancy, mortality is at its highest. Vertical transmission to the new-born occurs in 50% if mothers are positive for HEV PCR at the time of delivery. Premature deliveries, miscarriages and stillbirths have been reported.2 Jaundice in pregnancy is an important medical disorder seen more often in developing countries than in developed ones. It could be peculiar to the pregnancy viz., acute fatty liver of pregnancy, recurrent cholestatic jaundice in pregnancy and jaundice complicating toxaemia of pregnancy. ABSTRACTBackground: Hepatitis E virus is a non-envelope RNA virus responsible for large epidemics in Asia, the Middle east Mexico and Africa. It spreads via the feco-oral route, and has an incubation period of 8-10 weeks. The objective of the study was to find out the effect of hepatitis E during pregnancy on faeto-maternal outcome. Methods: A study on faeto-maternal outcome of 38 pregnant women admitted with jaundice due to hepatitis E to the Department of Hepatology, Shri Ramachandra Bhanj (SCB) Medical College, Cuttack, Odisha, India during January 2015 to December 2015. Results: 38 Pregnant women admitted to the Department of Hepatology of SCB Medical College, Cuttack, Odisha, India were studied. 65.7% were from rural area, 92.1% were in their third trimester of pregnancy. Serum bilirubin >10 mg in 52.19 %, SGOT, SGPT and alkaline phosphatase were raised in majority of them. Out of 38 women 32 delivered and 6 remain undelivered. In 81.25% of cases labor was spontaneous, perinatal mortality was observed in 46.87% of cases and 5 women died during child birth. Conclusions: When pregnancy is associated with jaundice due to hepatitis E, there is high perinatal and maternal morbidity and mortality. Early diagnosis and careful management is required for such cases.

To study the efficacy of intraoperative IV oxytocin and intramuscular (IM) oxytocin versus conventional intramuscular oxytocin alone for active management of the third stage of labor in lower segment cesarean section (CS). The study was performed to determine the effect of 5 IU (International Unit) oxytocin infusion at the time of skin incision and that of 10 IU IM oxytocin infusion after delivery in reducing blood loss during and after CS, in comparison with the effect of administrating conventional 10 IU IM oxytocin in the same time period. In addition, it assessed the ability of the IV+IM oxytocin group to reduce the need for additional uterotonic as well as its safety determination and postoperative blood transfusion in CS. ResultsThe study showed that the IV+IM group had a mean blood loss of 316.5 ± 74.36 ml, while the IM group had a mean loss of 403.90 ± 107.2 ml (p-value < 0.001) from placental delivery to the end of CS. A total of 90% of the patients in the IV+IM group had blood loss <50 ml compared to 95% of patients in the IM group who had a blood loss between 50 and 100 ml range from the end of cesarean to two hours postpartum. When total blood loss was compared in both groups, 84% of patients had a blood loss between 300 and 400 ml, compared to 81% of the patients in the IM group who had blood loss of 400-500 ml. Total blood loss in the IM group was 483.20 ± 115.86 ml, which was significantly higher compared to the IV group, 362.60 ± 78.07 ml (p-value=<0.001). Conclusion5IU oxytocin infusion at the time of skin incision and 10 IU IM oxytocin after delivery of the baby significantly reduced the amount of blood loss, need for blood transfusion, and additional uterotonics during and after lower segment CS.