Critical care of gynecological and obstetric patients: a decade of surgical intensive care experience

Despite the emergence of therapeutic advances, the morbidity and mortality still occur in the obstetric patients, although intensive care utilization by obstetric and gynecological patient, are still rare compared to the general population. Majority of obstetric patients needed the intensive care therapy compared to gynecological patients. The aim of our study was to know the indications for the intensive care admission by obstetric and gynecological patients, length of stay and outcome of these patients. We retrospectively reviewed the medical records of all obstetric and gynecological patients admitted to our Surgical and Trauma Intensive Care Units [SICU and TICU] from February 1995 to March 2005. Indication for admission, nationality, age, and length of stay in ICU, severity of disease and outcome of these patients were recorded. Data analyzed with SPSS program. A total of 182 patients were admitted to the SICU of the Hamad Medical Corporation in Doha, Qatar, from the Women's Hospital. 159 [87%] patients were obstetric patients and 23 [13%] patients gynecological patients, 126 [69.6%] patients were admitted post Lower Segment Caesarean Section [LSCS]. The most common indication for admission was 73 [39.3%] patients obstetric hemorrhage and Disseminated Intravascular Coagulation [DIC], and then 44 [25.3%] patients of hypertensive disorder of pregnancy. The major anesthesia related indication was scoline apnea, 21[11.6%]. Total three obstetric patients died, two due to severe sepsis and multi-organ failure and one due to cerebral sinus thrombosis, giving mortality rate of 1.66%. Intensive care therapy required by gynecological and obstetric patient is less than the general population. The commonest indication for admission was obstetric hemorrhage, DIC, and hypertensive disorders of pregnancy. The mortality was due to septic shock with multi-organ failure, and cerebral venous sinus thrombosis

Acute pancreatic nine years of surgical lCU experience

Acute pancreatitis has a variety of presentations from self-limiting abdominal pain to development of local and systemic complications resulting in sepsis, multi-organ dysfunction, extended intensive care stay and death. Very good quality of life in survivors justifies an optimal therapy in an intensive care setup. The records of 91 patients with acute pancreatitis were reviewed retrospectively. There was a significant difference [p<0.001] between those with edematous pancreatitis and those with necrotic pancreatitis as regards the length of ICU stay and severity scores: Ranson and SOFA [Sepsis-related Organ Failure Assessment]. The most common cause of pancreatitis was biliary [70.3 percent] followed by hyperlipidemia [12.1 percent], post ERCP [5.5 percent], trauma [4.4 percent], idiopathic [6.6 percent] and in one case, ascariasis. Common associated diseases were hypertension [33 percent] and diabetes mellitus [25.3 percent]. Six patients with necrotic pancreatitis died. It is concluded that acute pancreatitis treated in an intensive care unit has a favorable outcome and that a combination of Ranson and SOFA scores with CT index helps in establishing the prognosis

Hemolytic uraemic syndrome associated with pregnancy

Hemolytic uraemic syndrome [HUS] and thrombotic thrombocytopenic purpura [TTP] are described as acute syndromes with multisystem abnormalities and pentad of thrombocytopenia, microangiopathic hemolysis, neurological symptoms, renal impairment and fever. Both diseases were believed to form a continuum of the same disease, but recently it was found, that they were having a different pathophysiology, as TTP patients have a deficiency in von wilbrand factor [vWF] cleavage protease. When renal involvement is severe with little or no neurological manifestation, this microangiopathy is termed as haemolytic-uraemic syndrome. If the hemolytic uraemic syndrome is not associated with diarrhoea, it is called D-negative or atypical HUS. This subdivision is ofetiological and prognostic importance. TTP-HUS is associated with high maternal and fetal morbidity and mortality. Treatment of these syndromes differs from syndrome of hemolysis with elevated liver enzymes [HELLP syndrome] and acute fatty liver of pregnancy hence accurate diagnosis is important for optimal therapy. Plasma transfusion and plasmapheresis have revolutionized management of TTP and HUS by increasing survival 80% to 90%. Here we are reporting a case of D-negative hemolytic uraemic syndrome associated with pregnancy causing in-trauterine fetal death. Diagnosis made on clinical and he-matological findings, successfully treated by plasmapheresis with residual maternal renal impairment. We are presenting this case, as it is rare disorder associated with high mortality and morbidity, to increase awareness about disease, its diagnosis and management