Critical Care in Life Threatning Obstetrics Emergencies - PowerPoint PPT Presentation

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Critical Care in Life Threatning Obstetrics Emergencies

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Critical Care in Life Threatning Obstetrics Emergencies Can Save Mother and Child Dr. Sharda Jain Chairman, Dept of O/G - Pushpanjali Crosslay Hospital – PowerPoint PPT presentation

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Title: Critical Care in Life Threatning Obstetrics Emergencies


1
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
2
Causes of Maternal Mortality in India
  • Hemorrhage 25.6
  • 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 Miss Cases

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
  • HYPERTENSION CARDIAC
  • 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 is Sepsis 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 Fit
    3 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
18
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