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Critical Care in Life Threatning Obstetrics Emergencies – Can Save Mother and Child

Critical Care in Life Threatning Obstetrics Emergencies – Can Save Mother and Child. Dr. Sharda Jain Chairman, Dept of O/G - Pushpanjali Crosslay Hospital Director – Life Care Centre. Causes of Maternal Mortality in India. Hemorrhage 25.6% Sepsis 13%

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Critical Care in Life Threatning Obstetrics Emergencies – Can Save Mother and Child

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  1. Critical Care in Life Threatning ObstetricsEmergencies – Can Save Mother and Child Dr. Sharda Jain Chairman, Dept of O/G - Pushpanjali Crosslay Hospital Director – Life Care Centre

  2. Causes ofMaternal Mortality in India Hemorrhage25.6% Sepsis 13% Toxemia of pregnancy 11.9% Abortions 8% Obstructed labor 6.2% Other causes 35.3% (MMR – 407 per 100,000 live births) Source – Registrar General of India 2000

  3. Sentinel Events “Near MissCases”

  4. WHY We Require Critical Care? • Intensive Haemodynamic Monitoring & support • Invasive Haemodynamic Monitoring • Ventilation for Respiratory Failure • Monitoring for multi organ dysfunction

  5. What Obstetric/ medical Indications need transfer to HDU/ICU 2/3rd 1/3rd Obstetric Medical HEMORRHAGE Anemia HYPERTENSIONCARDIAC SEPSIS Respiratory Embolism HEPATIC COMA Endocrine Crisis

  6. What we normally do in ICU Methods of Monitoring Clinical and Basic Oxygen Saturation Hemodynamic Investigation Mental status P/R/T/BP Transcut Pulse Oximetry Invasive Pressure Monitoring Urine output Invasive: Mixed venous Intra-arterial CVP, Pulm artery catheter Capillary refill Oxygen saturation Coag , Profile

  7. Indications for invasive monitoring (Pulmonary artery catheter) Hypotension Massive blood loss Oliguria ARDS Pulmonary edema Amniotic fluid embolism Cardiac failure Cardiac disease

  8. Monitoring for multi Organ Dysfunction • Blood pressure • Urine output • Mental status • Respiratory insufficiency • Skin perfusion • Myocardial dysfunction • Coagulation activation

  9. What isSepsis Syndrome? SIRS Severe Sepsis Septic shock Fever Acidosis Hypotension despite Tachycardia Hypoxemia adequate fluid Tachypnea Oliguria resuscitation Leucocytosis Obtundation Leucopenia Coagulopathy Mortality – 25-30% Mortality – 40-70%

  10. “Near Miss” Cases & Sentinel Events Personal Series Of 46 Cases

  11. Causes Booked unbooked Haemorrhage 15 12 Hypertension/HELPP SYND 6 3 (79%) Heart Disease 2 0 undiagnosed Hepatic Disease 1HGE 2COMA Epileptic Fit3 0 Anaesthesia 2 0 TOTAL 29 17 (21%)

  12. HAEMORRAGE (N-16) Vaginal Delivery: Forceps 1 4 BT Acc. Hge 4 N. Delivery +PPH ↓ DIC (BT 4-15) PPH 2 Int. iliac Lig. 1 Int. iliac Lig. + Hyst 1

  13. HAEMORRHAGE CONTD.OPERATIVE DELIVERY • IInd Stage LSCS 2 - Hysterectomy • Pl. Accreta 7 No Scar -4 27,29,38,37 • Previous LSCS-3 • 31,31,33,

  14. NON OBSTETRIC CAUSES (9) • Anesthesia 2 Reversal • H. Disease 2 Undiag. →Pulmonary Odema • Hepatic Disease 2 Hge-LSCS-Hyst -1 Coma- 1 • Epileptic fits 3 Postpartum-2 Antepartum - 1

  15. HYPERTENSION-6 • Eclampsia – Nil • Hypert. + Sup., PIH – 4 (27-32 weeks) Alb +++ - ++++ Gen. Odema • HELPP- Syndrome -2

  16. FROM OUTSIDE HAEMORRHAGE – 12 Accidental Hge. - 5 Moribund-1 – Couvalaire Ut. – Hyst - Died on 13th day IR - RF APH – 4 Couvalaire ut. At LSCS – 1IUD /3 Alive 3 Post LSCS → Hysterectomy, Hypot, Coag Disorder→ SICU PPH 2 – Moribund → Hysterectomy needed IInd Trimester in termination – Bleeds +++ → Septicemia + ↓ BP, Ab. Coag. Hysterectomy Needed IInd Trimester IUD aborted out side. S. Bleeding – DIC-Renal Faliure, SICU

  17. FROM OUTSIDE • Hypertension – HELPP Synd. – 3 29,32,33 Mild DIC → Liver anzymes ↑ LSCS ↓ Platlates R-RF Hepatic coma IUD 2 Vaginal Delivery -1 Died -1

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