Clinical Characteristics and Outcome of Obstetric Patients Who Required Mechanical Ventilation in a Tertiary Care Hospital in North Kerala.

Objectives: To describe the clinical characteristics of obstetric patients requiring mechanical ventilation in a tertiary referral hospital and their maternal and perinatal outcome in order to identify their risk factors and clinical outcome and determine adverse prognostic factors in these patients. Study design: A prospective study was conducted in the Dept. of Obstetrics and Gynecology, Government Medical College, Kozhikode on all pregnant women up to 6 weeks postpartum from January 1, 2011 to December 31, 2013 and who subsequently required mechanical ventilation. Data was recorded in a predesigned proforma and was analyzed and frequency, and percentages were calculated. Results: In the 3-year period, 75 obstetric patients required mechanical ventilation. Majority were between 20-35 years (88%) and were primipara (53.3%). Eighty percent were admitted in the antepartum period and most were in the gestational age of 30-36 weeks (41.3%). Hypertensive disorder is an important antepartum complication (29.3%). Postpartum hemorrhage was the important cause (45.3%) of ICU admission. About 49.3% required mechanical ventilation for <24 hours and multiorgan failure was the important complication encountered (13.3%). Conclusions: Providing optimal prenatal care and improving the management of hemorrhagic complications and hypertensive disease can improve the morbidity and mortality of critically ill obstetric patients requiring mechanical ventilation.

Intussusception in Pregnancy: A Rare Case Report.

Intussusception is a surgical emergency characterized by invagination of a segment of bowel into a distal portion. It leads to obstruction and compromise of mesenteric blood flow with resultant inflammation and the potential for ischemia of the bowel wall. It is very rare in pregnancy, and the high fetal and maternal mortality is due to a delay in diagnosis and treatment. We report a case of intussusception at a gestational age of 14 weeks and 6 days, when she presented with severe lower abdominal pain and vomiting. Diagnosis was confirmed by ultrasonography which revealed heteroechoic bowel in bowel appearance. Emergency laparotomy was done. Lead point was a submucosal lipoma at 60 cm from the ileocecal junction. Iloeocecal intussusception reduction and segmental ileal resection and end-to-end anastomosis was done. The post-operative period was uneventful.