Quantification of disorders in obstetrics needing intensive care in a low resource setting

Abstract

SummaryBackground: Many disorders can occur during pregnancy, labour, postpartum. Some women become normal, some seriously ill and some die. It is essential to know disorders' burden.Objectives: of present study were to know burden of disorders, which cause severe illnesses, during pregnancy, birth, post birth, profile of such cases.Material Methods: Analysis of profile of cases admitted over 5 years at rural referral institute was done. Criteria was admission to intensive care area with system for ventilatory support in obstetric department.Results: Majority of women were of 20-29 years, mean age 24 years, 2.6% adolescents. 39.7% were rural, 36.2% urban, 24.1% from urban settlements with low resources, 69.7% were antenatal, 18.5% intranatal, 11.8% postnatal. Sixty two percent were nullipara. Severe morbidity had 'U' curve in relation to age. Hypertensive disorders (53% of severely ill cases) were commonest basic disorder, next were medical disorders (26%)(severe anaemia, heart disease, malaria, infective hepatitis, pneumonia).Others were, late haemorrhage 12%, (antepartum and postpartum haemorrhage), early pregnancy complications(abortions, ectopic pregnancy, hydatiform mole) 5%, puerperal sepsis 2%, acute fatty liver of pregnancy 1.2%, rupture uterus 0.8%. Conclusion:Severe maternal morbidity with reference to age followed a 'U' curve. More cases were primigravida. Highest ratio was of cases from low resource urban settlements. Majority of severely ill cases were antenatal, some postnatal too. Commonest primary cause of severe illness was hypertensive disorders, followed by medical disorders, haemorrhage, complications of early pregnancy, puerperal sepsis, acute fatty liver of pregnancy, rupture uterus in descending order. Quality maternal care, at primary level, timely referral, quality maternal care at referral is essential. Also a lot of research is needed for prevention of some disorders, their severity.

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“…Taly et al 31 reported hemorrhage as the leading cause of severe illness. Simkhada et al 32 reported PPH responsible for 46% cases of mortality and morbidity, obstructed labor for 16% and eclampsia 14%.…”