Critical Care in Life Threatning Obstetrics Emergencies

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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
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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

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Sentinel Events

• Near Miss Cases

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WHY We Require Critical Care?

• Intensive Haemodynamic Monitoring support
• Invasive Haemodynamic Monitoring
• Ventilation for Respiratory Failure
• Monitoring for multi organ dysfunction

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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

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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

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Indications for invasive monitoring (Pulmonary
artery catheter)

• Hypotension Massive blood loss
• Oliguria ARDS
• Pulmonary edema Amniotic fluid embolism
• Cardiac failure Cardiac disease

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Monitoring for multi Organ Dysfunction

• Blood pressure
• Urine output
• Mental status
• Respiratory insufficiency
• Skin perfusion
• Myocardial dysfunction
• Coagulation activation

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• 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

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Near Miss Cases Sentinel Events

• Personal Series Of
• 46 Cases

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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)

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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

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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,

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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

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HYPERTENSION-6

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

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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

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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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