Critically ill obstetric patients requiring mechanical ventilation in rural western India: A retrospective analysis.

Background. There is a dearth of studies on the clinical profile and therapeutic aspects of critically ill obstetric patients from rural areas, especially those requiring tertiary care support and ventilator therapy. Methods. We retrospectively analysed the aetiological, clinical, interventional and outcome-related factors of obstetric patients requiring mechanical ventilation in western India. We analysed factors that influence seeking of antenatal care, pregnancy and its complications, severity assessment score, indications and initiation of mechanical ventilation, multiorgan failure and their correlation with maternal mortality. Results. Of the 6708 obstetric admissions studied, 1112 were of critically ill (16.5%) patients and 200 (17%) of these required mechanical ventilation. Over three-fourths (77%) of patients were from rural areas, 83.5% were referred and 97% had inadequate antenatal care. Severe pregnancy-induced hypertension/eclampsia, massive haemorrhage and sepsis were the common obstetric complications. Pulmonary oedema (32.5%), acute respiratory distress syndrome (ARDS, 14%) and acute lung injury (22.5%) were the three most common indications for mechanical ventilation. In 26% of patients, mechanical ventilation was initiated early based on a worsening cardiorespiratory profile. A sequential organ failure assessment score of >5 on admission and delay in treatment resulted in multi-organ failure and worsening outcome. The maternal mortality ratio was 32.5%, incidence of multi-organ dysfunction syndrome was 71%, and pregnancy loss was 43.5%. The odds ratio for maternal mortality in patients ventilated early was 0.39 as against 5 in those with ARDS. Conclusions. Inadequate antenatal care, delayed referral practices, pregnancy-induced hypertension, obstetric haemorrhage and sepsis remain the major causes of complications in obstetric patients from rural areas. The common indications for mechanical ventilation were pulmonary oedema, ARDS and acute lung injury. Early initiation of mechanical ventilation upon detection of imminent

Spleenic rupture in pregnancy - in a rural based tertiary care hospital.

Traumatic rupture of spleen is an uncommon but important clinical entity. This case report illustrates difficulty of this unrecognized diagnosis and remind us to suspect a spleenic rupture in from of any pregnant women with a typical abdominal pain and haemorrhagic shock.without any obvious obstretrical cause, with the history of fall or truma.

Congenital malformation - A biological accident (A 6 years 9 months study in a rural based tertiary care hospital).

Background: Birth of live congenitally abnormal child especially at term is a great mental and social trauma to parents, family and to the society. In developed countries it is one of the main causes of infant mortality. It accounts 8-15% of peri-natal deaths and 13-16% of neonatal deaths in India. Aims & Objectives : To find out the incidence of congenital anomalies in live and still births and to find out association of major and minor anomalies to maternal demographic profile and to various obstetrics and medical parameters. Materials & Methods: This study was carried on rural based tertiary care referral hospital. All the deliveries occurred during 1st September 2004 to 30th June 2011 (81months) comprised 7053 births were enrolled. The new born were examined systematically by obstetrician and pediatrician. System wise distribution of anomalies and correlation with risk factors were analyzed. Results: Out of total 7053 deliveries, 6433 were live births and 620 were still births. Total number of congenital malformed babies were 71 (1.006%). 31 (43.66%) of the 71 malformed babies were still born and 27 (38.02%) were NND (neonatal death). It means out of 100 stillborn, 43 babies had structural malformation. Major malformation was present in 58 and minor anomalies were present in 13 fetus. Marginal Male predominance 40 (56.33 %) was noted. Central nervous system malformation was most common in live births followed by respiratory system and musculo skeletal system. 64% patients had not taken ANC (antenatal care) and in them 92% had major anomalies. 81.3% anomalies were detected by 2nd trimester USG (ultra sonography) and 18% anomalies were not detected by USG out of which 98% were minor anomalies. Conclusion: Congenital anomalies are a major cause of still births and infant mortality. Regular ANC, 2nd trimester USG for early detection and folic acid supplementation for prevention are the important factors to be considered to decrease the burden of congenital malformation.