A 1 year prospective analysis of all critically ill obstetric patients admitted to a newly developed dedicated obstetric intensive care unit (ICU) was done in order to characterize causes of admissions, interventions required, course and foetal maternal outcome. Utilization of mortality probability model II (MPM II) at admission for predicting maternal mortality was also assessed. During this period there were 16,756 deliveries with 79 maternal deaths (maternal mortality rate 4.7/1000 deliveries). There were 24 ICU admissions (ICU utilization ratio 0.14%) with mean age of 25.21±4.075 years and mean gestational age of 36.04±3.862 weeks. Postpartum admissions were significantly higher (83.33% n=20, P<0.05) with more patients presenting with obstetric complications (91.66%, n=22, P<0.01) as compared to medical complications (8.32% n=2). Obstetric haemorrhage (n=15, 62.5%) and haemodynamic instability (n=20, 83.33%) were considered to be significant risk factors for ICU admission (P=0.000). Inotropic support was required in 22 patients (91.66%) while 17 patients (70.83%) required ventilatory support but they did not contribute to risk factors for poor outcome. The mean duration of ventilation (30.17±21.65 h) and ICU stay (39.42±33.70 h) were of significantly longer duration in survivors (P=0.01, P=0.00 respectively) versus non-survivors. The observed mortality (n=10, 41.67%) was significantly higher than MPM II predicted death rate (26.43%, P=0.002). We conclude that obstetric haemorrhage leading to haemodynamic instability remains the leading cause of ICU admission and MPM II scores at admission under predict the maternal mortality.
BACKGROUND: Wound infiltration with local anesthetics and opioids is increasingly being used as a part of multimodal postoperative analgesia. OBJECTIVES: A prospective randomized double blind placebo controlled study was conducted to investigate the efficacy of wound infiltration using bupivacaine versus ropivacaine with fentanyl for postoperative analgesia. METHOD: 93 female patients of ASA grade I/II posted for abdominal hysterectomy under spinal anesthesia were randomly divided into three groups destined to receive wound infiltration at the end of surgery using 14.5 ml 0.5% isobaric solution of either bupivacaine or ropivacaine along with 0.5 ml (25 mcg) fentanyl in group BF and RF respectively, and with 15 ml normal saline in control group (Group S). All patients received diclofenac 75 mg I.M. (B.D.) and rescue analgesic butorphanol 1 mg was given if pain occurs. Postoperative analgesia in terms of visual analogue score rescue opioids consumption in 24 hour period, and satisfaction score of patient, surgeon and anesthesiologist was compared. Rescue opioid (butorphanol) consumption in 24 hours was significantly higher in group S (61 mg), as compared to group BF (21 mg) and group RF (26 mg), p= 0.000. However group BF and group RF were comparable p=0.473. (Group S > group RF~ Group BF). Mean VAS score at rest, cough and movement was significantly less and satisfaction of patient, surgeon and anesthesiologist was significantly higher in group BF than in group RF than in group S, p<0.05. CONCLUSION: We conclude that wound infiltration using bupivacaine or ropivacaine with fentanyl is an easy, safe and effective technique for providing postoperative analgesia. Moreover, bupivacaine seems to be superior to ropivacaine in wound infiltration in terms of significantly less pain score and better satisfaction score.
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