Prospective evaluation of maternal morbidity and mortality in post-cesarean section patients admitted to postanesthesia intensive care unit

Harde, Minal; Dave, Sona; Wagh, S. S.; Gujjar, Pinakin; Bhadade, Rakesh; Bapat, Aarati

doi:10.4103/0970-9185.142844

Cited by 16 publications

(33 citation statements)

References 15 publications

(50 reference statements)

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“…The mean age and the age distribution of the critically ill obstetric patients in the present study correlate with other contemporary Indian studies,[172021222324] but studies from abroad report a higher maternal age. [11131415] Although advanced maternal age has not been shown to be uniformly associated with CCU admissions and a median age of 30 years is consistent with birth age patterns in developed countries,[27] the noteworthy point in Indian studies is the need of critical care in the patients well under thirty.…”

Section: Discussionsupporting

confidence: 90%

Critically ill obstetric patients in a general critical care unit: A 5 years′ retrospective study in a public teaching hospital of Eastern India

Dasgupta

Jha

Bagchi

et al. 2017

Indian Journal of Critical Care Medicine

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Background:Critical care services are essential for the subset of obstetric patients suffering from severe maternal morbidity. Studies on obstetric critical care are important for benchmarking the issues which need to be addressed while managing critically ill obstetric patients. Although there are several published studies on obstetric critical care from India and abroad, studies from Eastern India are limited. The present study was conducted to fill in this lacuna and to audit the obstetric critical care admissions over a 5 years’ period.Settings and Design:Retrospective cohort study conducted in the general critical care unit (CCU) of a government teaching hospital.Materials and Methods:The records of all obstetric patients managed in the CCU over a span of 5 years (January 2011-December 2015) were analyzed.Results:During the study, 205 obstetric patients were admitted with a CCU admission rate of 2.1 per 1000 deliveries. Obstetric hemorrhage (34.64%) was the most common primary diagnosis among them followed by pregnancy-induced hypertension (26.83%). Severe hemorrhage leading to organ failure (40.48%) was the main direct indication of admission. Invasive ventilation was needed in 75.61% patients, and overall obstetric mortality rate was 33.66%. The median duration (in days) of invasive ventilation was 2 (interquartile range [IQR] 1-7), and the median length of CCU stay (in days) was 5 (IQR 3-9).Conclusions:Adequate number of critical care beds, a dedicated obstetric high dependency unit, and effective coordination between critical care and maternity services may prove helpful in high volume obstetric centers.

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Section: Discussionsupporting

confidence: 90%

Critically ill obstetric patients in a general critical care unit: A 5 years′ retrospective study in a public teaching hospital of Eastern India

Dasgupta

Jha

Bagchi

et al. 2017

Indian Journal of Critical Care Medicine

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“…Finally, in this study, we confirm data from others that mortality in women admitted to an ICU is low, as a result of improved intensive care [14]. …”

Section: Discussionsupporting

confidence: 78%

Obstetric Admissions to the Intensive Care Unit in a Tertiary Hospital

Greve

Mieghem²,

Berghe³

et al. 2016

Gynecol Obstet Invest

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Aims: A better understanding of the characteristics of obstetric patients admitted to an intensive care unit (ICU) could guide where the focus of obstetric training and awareness should be directed at to reduce further maternal mortality and morbidity. Methods: We retrospectively assessed the charts of all women admitted during pregnancy or postpartum to a tertiary ICU over a 12-year period. We retrieved whether women were followed locally or referred from another hospital and whether the ICU admission was prophylactic or therapeutic. Results: There were 190 admissions in 183 women. One-hundred and four admissions were in referred women and 86 in women cared for locally. Seventy-eight admissions (41.1%) were for direct obstetric causes (primarily postpartum hemorrhage (n = 14), hypertensive disorders of pregnancy (n = 12) and peripartum cardiomyopathy (n = 10)). Indirect obstetric admissions (n = 89; 46.8%) were primarily for cardiopathies (n = 35) and pulmonary diseases (n = 18). Among non-obstetric admissions, trauma (n = 6; 26.1%) and neurologic tumors (n = 6; 26.1%) were the most common. Conclusion: Pre-existing and acquired cardiopathies are the main reason for admission to an ICU in a developed country and have surpassed hypertensive disorders and hemorrhage. This should become a focus of obstetric care provider training.

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“…The rate of post-partum hemorrhage in this study was 1.68% (95% CI (0.684%, 3.46%)) which was similar to what was found in Australia and central Saudi Arabia [29,30] but much lower than the finding from Pakistan (22%) [25]. Endometritis, uterine rupture, hysterectomy and transfusion requiring bleedings occurred in 3.36%, 0.6%, 1.7% and 2.8% of the women respectively comparable with complication rates among mothers with prior CS scar [18].There was one (0.28% (95% CI 0.27-0.87)) maternal death similar to findings in Sub Saharan Africa and other parts of Ethiopia [7,9,31] but less than the findings from Nigeria or India [32,33]. This variations might be due to differences in sample size.…”

Section: Socio-demographic Characteristics Of the Mothersmentioning

confidence: 55%

Post-Cesarean Section Maternal Health Outcome and its Determinants in Tigray Regional State, North Ethiopia.

Abay

Gebremariam

Kurie

et al. 2019

Preprint

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Back ground Cesarean section rate is increasing worldwide. However, the World Health Organization has declared that there is insufficient information on maternal outcome following cesarean section for decision making.Objective The aim of this study was to assess post cesarean section maternal outcome and its associated factors availing evidence for practice and policy.Methods Institution based cross-sectional study was conducted among 357 mothers who underwent cesarean section in six selected public general hospitals of Tigray regional State, Ethiopia. Mothers were followed for the duration of post-operative period until they became safe for discharge. The maternal outcomes were categorized into either adverse or good outcomes depending on whether mothers develop any cesarean section related morbidity or not. Logistic regression model was constructed to determine the AOR and 95% CI of independent factors associated with maternal outcome following cesarean section.Results The proportion of adverse maternal outcome was 19.3% with 95% CI of (15.7% -23.8%). Route of anesthesia administration (AOR = 0.296, 95% CI: 0.126 - 0.695) and referral status (AOR = 0.371, 95%CI: 0.214 - 0.641) were statistically significant factors associated with maternal outcome following cesarean section.Conclusion There was high proportion of adverse maternal outcome. General anesthesia and referral from lower health facilities were associated with higher risk of post-CS adverse maternal outcome. Equipping lower level health facilities with the human and material capacity for timely detection of CS indications and provision of cesarean section services could decrease the number of referrals and subsequent delays that lead to adverse maternal outcome.

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Prospective evaluation of maternal morbidity and mortality in post-cesarean section patients admitted to postanesthesia intensive care unit

Cited by 16 publications

References 15 publications

Critically ill obstetric patients in a general critical care unit: A 5 years′ retrospective study in a public teaching hospital of Eastern India

Critically ill obstetric patients in a general critical care unit: A 5 years′ retrospective study in a public teaching hospital of Eastern India

Obstetric Admissions to the Intensive Care Unit in a Tertiary Hospital

Post-Cesarean Section Maternal Health Outcome and its Determinants in Tigray Regional State, North Ethiopia.

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