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Gebremariam BM, Aboye GT, Dessalegn AA, Simegn GL. Rule-based expert system for the diagnosis of maternal complications during pregnancy: For low resource settings. Digit Health 2024; 10:20552076241230073. [PMID: 38313364 PMCID: PMC10836132 DOI: 10.1177/20552076241230073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 02/06/2024] Open
Abstract
Objectives Maternal complications are health challenges linked to pregnancy, encompassing conditions like gestational diabetes, maternal sepsis, sexually transmitted diseases, obesity, anemia, urinary tract infections, hypertension, and heart disease. The diagnosis of common pregnancy complications is challenging due to the similarity in signs and symptoms with general pregnancy indicators, especially in settings with scarce resources where access to healthcare professionals, diagnostic tools, and patient record management is limited. This paper presents a rule-based expert system tailored for diagnosing three prevalent maternal complications: preeclampsia, gestational diabetes mellitus (GDM), and maternal sepsis. Methods The risk factors associated with each disease were identified from various sources, including local health facilities and literature reviews. Attributes and rules were then formulated for diagnosing the disease, with a Mamdani-style fuzzy inference system serving as the inference engine. To enhance usability and accessibility, a web-based user interface has been also developed for the expert system. This interface allows users to interact with the system seamlessly, making it easy for them to input relevant information and obtain accurate disease diagnose. Results The proposed expert system demonstrated a 94% accuracy rate in identifying the three maternal complications (preeclampsia, GDM, and maternal sepsis) using a set of risk factors. The system was deployed to a custom-designed web-based user interface to improve ease of use. Conclusions With the potential to support health services provided during antenatal care visits and improve pregnant women's health outcomes, this system can be a significant advancement in low-resource setting maternal healthcare.
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Affiliation(s)
| | - Genet Tadese Aboye
- School of Biomedical Engineering, Jimma Institute of Technology, Jimma University, Jimma, Ethiopia
| | - Abebaw Aynewa Dessalegn
- Department of Midwifery, Jimma Institute of Health sciences, Jimma University, Jimma, Ethiopia
| | - Gizeaddis Lamesgin Simegn
- School of Biomedical Engineering, Jimma Institute of Technology, Jimma University, Jimma, Ethiopia
- Artificial Intelligence & Biomedical Imaging Research Lab, Jimma Institute of Technology, Jimma University, Jimma, Ethiopia
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Foessleitner P, Budil MC, Mayer S, Kraft F, Zeilberger MS, Deinsberger J, Farr A. Peripartum Maternal Admission to the Intensive Care Unit: An Observational Study over a 15-Year Period at a Tertiary Center in Austria. J Clin Med 2023; 12:5386. [PMID: 37629428 PMCID: PMC10455968 DOI: 10.3390/jcm12165386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/10/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
Peripartum maternal admission to the intensive care unit is challenging for anesthesiologists, obstetricians, and all personnel involved. An understanding of altered maternal physiology, fetal considerations, and acute peripartum emergencies is required to ensure adequate maternal and neonatal outcomes. In this study, we analyzed data of peripartum maternal admissions to the intensive care unit at our large tertiary referral center in order to define trends and changes over time. This study retrospectively analyzed maternal morbidity, admission diagnoses, treatments, and outcomes of women with peripartum admission to the intensive care unit at our tertiary care center over a 15-year period. We found that patient characteristics and admission diagnoses remained remarkably consistent over the observational period; however, there was a significant increase in postpartum hemorrhage (r = 0.200, p < 0.001) and cesarean hysterectomy (r = 0.117, p = 0.027) over time. Moreover, we found a reduction in preterm births (r = -0.154, p = 0.004) and a decreased peripartum neonatal intensive care unit admission rate (r = -0.153, p = 0.006) among women who were transferred to the intensive care unit. Based on our long-term observational data, there is consistent need for intensive care in obstetrics due to a small number of different etiologies. Specialized training for the predominant diagnoses involved as well as multidisciplinary care of the affected patients are both warranted.
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Affiliation(s)
- Philipp Foessleitner
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (P.F.)
| | - Marie-Christin Budil
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (P.F.)
| | - Stefanie Mayer
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (P.F.)
| | - Felix Kraft
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Mira Stephanie Zeilberger
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Julia Deinsberger
- Department of Dermatology, Medical University of Vienna, 1090 Vienna, Austria
| | - Alex Farr
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, 1090 Vienna, Austria; (P.F.)
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3
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Lazzaroni MG, Crisafulli F, Moschetti L, Semeraro P, Cunha AR, Neto A, Lojacono A, Ramazzotto F, Zanardini C, Zatti S, Airò P, Tincani A, Franceschini F, Andreoli L. Reproductive Issues and Pregnancy Implications in Systemic Sclerosis. Clin Rev Allergy Immunol 2022; 64:321-342. [PMID: 35040084 DOI: 10.1007/s12016-021-08910-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2021] [Indexed: 12/26/2022]
Abstract
Systemic sclerosis (SSc) is a rare systemic autoimmune disease that can influence reproductive health. SSc has a strong female predominance, and the disease onset can occur during fertility age in almost 50% of patients. Preconception counseling, adjustment of treatment, and close surveillance during pregnancy by a multidisciplinary team, are key points to minimize fetal and maternal risks and favor successful pregnancy outcomes. The rates of spontaneous pregnancy losses are comparable to those of the general obstetric population, except for patients with diffuse cutaneous SSc and severe internal organ involvement who may carry a higher risk of abortion. Preterm birth can frequently occur in women with SSc, as it happens in other rheumatic diseases. Overall disease activity generally remains stable during pregnancy, but particular attention should be paid to women with major organ disease, such as renal and cardiopulmonary involvement. Women with such severe involvement should be thoroughly informed about the risks during pregnancy and possibly discouraged from getting pregnant. A high frequency of sexual dysfunction has been described among SSc patients, both in females and in males, and pathogenic mechanisms of SSc may play a fundamental role in determining this impairment. Fertility is overall normal in SSc women, while no studies in the literature have investigated fertility in SSc male patients. Nevertheless, some considerations regarding the impact of some immunosuppressive drugs should be done with male patients, referring to the knowledge gained in other rheumatic diseases.
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Affiliation(s)
- Maria-Grazia Lazzaroni
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Francesca Crisafulli
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Liala Moschetti
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Paolo Semeraro
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Ana-Rita Cunha
- Rheumatology Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
| | - Agna Neto
- Rheumatology Department, Hospital Central do Funchal, Madeira, Portugal
| | - Andrea Lojacono
- Obstetrics and Gynaecology Unit, ASST Garda Ospedale of Desenzano, Desenzano del Garda, Italy
| | | | - Cristina Zanardini
- Obstetrics and Gynaecology Unit, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Sonia Zatti
- Obstetrics and Gynaecology Unit, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Paolo Airò
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy.,I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Franco Franceschini
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Laura Andreoli
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy.
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Prevalence of postpartum acute kidney injury among patients undergoing hemodialysis at Edward Francis Small Teaching hospital. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2022. [DOI: 10.1016/j.ijans.2021.100391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Burn MS, Sheth SS, Sheth KN. Neurocritical care of the pregnant patient. HANDBOOK OF CLINICAL NEUROLOGY 2021; 171:205-213. [PMID: 32736751 DOI: 10.1016/b978-0-444-64239-4.00011-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
INTRODUCTION An estimated 0.1%-0.8% of obstetric patients require admission to an intensive care unit (ICU) during pregnancy or the puerperium. When neurologic emergencies occur in pregnancy, collaboration between the neurointensivist, obstetric anesthesiologist, and obstetrician is key in minimizing morbidity and mortality. PRINCIPLES Care of the critically ill pregnant patient mirrors that of the critically ill nonpregnant patient with some minor exceptions. Special care must be taken to consider the normal physiologic changes of pregnancy as well as possible fetal exposure to medical interventions. Timing and method of delivery must be carefully considered when caring for patients with neurologic emergencies. Common neurologic emergencies in pregnancy include hypertensive disorders of pregnancy, intracranial neoplasms, noneclamptic seizures, cerebrovascular disorders, and ventriculoperitoneal shunt malfunctions. CONCLUSION While neurologic emergencies in pregnancy are overall rare, when they do occur, they can be devastating. As in the nonpregnant population, prompt recognition and rapid intervention are crucial in optimizing patient outcomes. When neurologic emergencies occur in pregnancy, maternal and fetal care is optimized through a multidisciplinary care team.
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Affiliation(s)
- Martina S Burn
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, CT, United States
| | - Sangini S Sheth
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, CT, United States
| | - Kevin N Sheth
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States.
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6
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Ramlakhan KP, Gommers D, Jacobs CERM, Makouri K, Duvekot JJ, Reiss IKM, Franx A, Roos-Hesselink JW, Cornette JMJ. Women of reproductive age in a tertiary intensive care unit: indications, outcome and the impact of pregnancy-a retrospective cohort study. BMC WOMENS HEALTH 2021; 21:248. [PMID: 34147093 PMCID: PMC8214372 DOI: 10.1186/s12905-021-01396-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 05/31/2021] [Indexed: 08/26/2023]
Abstract
Background To evaluate the indications for admission and mortality rates of women of reproductive age admitted to a tertiary Intensive Care Unit (ICU) and to compare the outcomes of obstetric and non-obstetric admissions.
Methods
A retrospective cohort study was performed, including all women aged 17–41 years admitted to a level 3 ICU in the Netherlands, between January 1, 2000 and January 1, 2016. Primary outcome was indication for admission and mortality. Mortality, length of stay (LOS), need for mechanical ventilation and APACHE II score were compared between obstetric and non-obstetric admissions. The obstetric group was further analyzed for maternal and perinatal outcomes. Results 3461 women (median age 32 years) were included, with an overall mortality rate of 13.3%. The obstetric group consisted of 265 women (7.7%). The non-obstetric group (n = 3196) was admitted most often for cardiovascular disease (19.6%), followed by oncologic disease (15%). Mortality was the highest in women with oncologic disease (23.9%). The obstetric group had lower mortality compared to the non-obstetric group (4.9% vs. 14%, p < 0.001), despite higher APACHE II score (14 vs. 11, p < 0.001) and a higher ventilation rate (47.9% vs. 39%, p = 0.004). Major surgical or endovascular interventions, besides caesarean section, were performed in 46% of the obstetric group. Perinatal death occurred in 17.2% and of the surviving infants, 63.2% were born preterm and 45.1% required Neonatal Intensive Care Unit admission. Conclusions Cardiovascular disease is the most important indication for admission and oncologic disease is associated with highest mortality in women of reproductive age. Obstetric patients constitute a small percentage of all ICU admissions in a tertiary ICU center. They have lower mortality rates than non-obstetric young female patients, despite a more severe initial presentation. Nevertheless lasting maternal morbidity and perinatal mortality and morbidity is frequent.
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Affiliation(s)
- Karishma P Ramlakhan
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Diederik Gommers
- Department of Adult Intensive Care Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Carmen E R M Jacobs
- Department of Obstetrics and Gynecology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Khaoula Makouri
- Department of Obstetrics and Gynecology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Johannes J Duvekot
- Department of Obstetrics and Gynecology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Irwin K M Reiss
- Division of Neonatology, Department of Pediatrics, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Arie Franx
- Department of Obstetrics and Gynecology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jolien W Roos-Hesselink
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Jérôme M J Cornette
- Department of Obstetrics and Gynecology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Miglani U, Pathak AP, Laul P, Sarangi S, Gandhi S, Miglani S, Laul A. A Study of Clinical Profile and Fetomaternal Outcome of Obstetric Patients Admitted to Intensive Care Unit: A Prospective Hospital-based Study. Indian J Crit Care Med 2021; 24:1071-1076. [PMID: 33384513 PMCID: PMC7751057 DOI: 10.5005/jp-journals-10071-23657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aims and objectives To study clinical profile of obstetric patients admitted to intensive care unit (ICU) and to analyze the relation of demographic factors such as age, parity, literacy level, socioeconomic status, acute physiology and chronic health evaluation II (APACHE II) score, and level of delay with fetomaternal outcome. Design It is a prospective cross-sectional observational study. Materials and methods After admission to ICU a detailed history, analysis of basic demographic variables along with level of delay was done. APACHE II score was calculated. These parameters were correlated with fetomaternal outcome. The Chi-squared test was used to compare categorical variables. The one-way analysis of variance was used to compare the continuous variables among the strata with Tukey's post hoc test. Results Incidence of obstetric ICU admission was 0.77%. Mean age was 26.03 years. Most common indication of ICU admission was obstetrical hemorrhage (37.1%) followed by hypertensive disorders of pregnancy (25.8%). Type I delay was the most common followed by type II delay. Mean APACHE II score was 14.77 ± 6.85. Observed mortality rate (30.6%) was found to be higher than predicted mortality rate (25%). APACHE II score was significantly high in the presence of level 1 (p = 0.003) and level 2 delays (p = 0.0001). Also, it was significantly increased with the duration of delays. Conclusion Unbooked and referred cases had high incidence of ICU admission. The presence of delay was associated with poor outcome. How to cite this article Miglani U, Pathak AP, Laul P, Sarangi S, Gandhi S, Miglani S, et al. A Study of Clinical Profile and Fetomaternal Outcome of Obstetric Patients Admitted to Intensive Care Unit: A Prospective Hospital-based Study. Indian J Crit Care Med 2020;24(11):1071-1076.
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Affiliation(s)
- Urvashi Miglani
- Department of Obstetrics and Gynecology, Deen Dayal Upadhyay Hospital, New Delhi, India
| | - Anjali P Pathak
- Department of Obstetrics and Gynecology, Deen Dayal Upadhyay Hospital, New Delhi, India
| | - Poonam Laul
- Department of Obstetrics and Gynecology, Deen Dayal Upadhyay Hospital, New Delhi, India
| | - Sushmita Sarangi
- Department of Anesthesia, Deen Dayal Upadhyay Hospital, New Delhi, India
| | - Shalini Gandhi
- Department of Medicine, KD Medical College, New Delhi, India
| | - Sanjeev Miglani
- Department of Medicine, Sir Gangaram Hospital, New Delhi, India
| | - Anish Laul
- Department of Medicine, Deen Dayal Upadhyay Hospital, New Delhi, India
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8
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Patel S, Estevez A, Nedeff N, Gascon J, Lee I. ICU management of the obstetric patient. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2020. [DOI: 10.1016/j.tacc.2020.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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9
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Benhamou D, Fuchs F, Mercier FJ. Obstetric critical care patients in France: Admission shift from general intensive care units (ICU) to general high-dependency units (HDU) and now to obstetric high-dependency units (OHDU)? Anaesth Crit Care Pain Med 2020; 38:331-333. [PMID: 31345408 DOI: 10.1016/j.accpm.2019.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- D Benhamou
- Département d'Anesthésie-Réanimation, Groupe Hospitalier (AP-HP) et Faculté de Médecine Paris Sud, Hôpital Bicêtre, 78 rue du Général Leclerc, Le Kremlin-Bicêtre cedex, 94270, France.
| | - F Fuchs
- Service de Gynécologie Obstétrique, CHU de Montpellier, Hôpital Arnaud de Villeneuve, 371, av. du Doyen Gaston Giraud, Montpellier cedex 5, 34295, France
| | - F J Mercier
- Département d'Anesthésie, Hôpital Antoine Béclère (Hôpitaux Universitaires Paris-Sud, AP-HP), 157, rue de la Porte de Trivaux, Clamart, 92140, France
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Krawczyk P, Jastrzębska A, Sałapa K, Szczeklik W, Andres J. Abnormal lung ultrasound pattern during labor: A prospective cohort pilot study. JOURNAL OF CLINICAL ULTRASOUND : JCU 2019; 47:261-266. [PMID: 30729529 DOI: 10.1002/jcu.22692] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/17/2018] [Accepted: 01/11/2019] [Indexed: 06/09/2023]
Abstract
PURPOSE Lung ultrasound (LUS) examination is used to evaluate patients with acute respiratory failure. The physiological LUS pattern during labor in healthy parturients has not been well described. The aim of this study was to evaluate the LUS pattern in a cohort of healthy women during uncomplicated labor. METHODS We used the 8-point LUS assessment protocol and investigated lung sliding, A-lines, B-lines, interstitial syndrome, lung consolidation, and pleural effusion according to the International Consensus Document with two additional supradiaphragmatic projections. All patients were screened twice; once during the first stage of labor and again within 2 hours after delivery. RESULTS We included 24 patients in this study from February 2014 to August 2015. A total of 480 LUS records were retained for further analysis. Overall, 16 of 24 patients (67%) had at least one positive region (three or more B-lines) during the peridelivery LUS evaluation. Interstitial syndrome was detected in five patients (21%). There were no differences in A-line (P = 0.38) or B-line (P = 0.68) prevalence between LUS examinations before and after delivery. CONCLUSIONS Women in uncomplicated labor can present abnormal LUS findings, which may affect the interpretation of LUS results in patients with respiratory deterioration. Further studies should address this topic in larger cohort of patients.
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Affiliation(s)
- Paweł Krawczyk
- Department of Anesthesiology and Intensive Care Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Agnieszka Jastrzębska
- Department of Anesthesiology and Intensive Care Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Kinga Sałapa
- Department of Bioinformatics and Telemedicine, Jagiellonian University Medical College, Cracow, Poland
| | - Wojciech Szczeklik
- Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Janusz Andres
- Department of Anesthesiology and Intensive Care Medicine, Jagiellonian University Medical College, Cracow, Poland
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Pandya1 ST, Mogal S, Kulkarni AP. Obstetric ICU: Analysing and Understanding the Data is Important. Indian J Crit Care Med 2019; 23:201-202. [PMID: 31160832 PMCID: PMC6535989 DOI: 10.5005/jp-journals-10071-23158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
How to cite this article: Pandya ST, Mogal S, Kulkarni AP. Obstetric ICU: Analysing and Understanding the Data is Important. Indian J Crit Care Med 2019;23(5):201-202.
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Affiliation(s)
- Sunil T Pandya1
- Department of Surgical and Obstetric Critical Care, Century Hospital, Hyderabad, Telangana, India
| | - Shwetha Mogal
- Department of Anesthesia, Pain Medicine and Obstetric Critical Care, Hyderabad, Telangana, India
| | - Atul P Kulkarni
- Department of Surgical and Obstetric Critical Care, Century Hospital, Hyderabad, Telangana, India
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Vargas M, Marra A, Buonanno P, Iacovazzo C, Schiavone V, Servillo G. Obstetric Admissions in ICU in a Tertiary Care Center: A 5-Years Retrospective Study. Indian J Crit Care Med 2019; 23:213-219. [PMID: 31160837 PMCID: PMC6535986 DOI: 10.5005/jp-journals-10071-23163] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background and Aim Obstetric patients admitted to intensive care unit (ICU) represent a challenge to physicians. The purpose of this study is to evaluate the incidence, characteristics, and mortality of pregnant and postpartum patients requiring ICU admission. Materials and Methods A retrospective cohort study was performed between January 2008 and December 2013 at the University Hospital Federico II of Naples including pregnant and puerperal women until the 42nd day of postpartum and admitted to ICU. Results Patients admitted with an obstetric diagnosis had a higher incidence of at least one previous cesarean section, were treated more with hysterectomy, had an increasing incidence of hemodynamic instability, had more postpartum admission, had a higher TISS-28 score, and required more endotracheal intubation than patients admitted with non-obstetrics diagnosis. Conclusion A shared approach including a close collaboration between ICU and obstetric ward may be useful to reduce ICU admission and to improve maternal and foetal outcomes. How to cite this article Vargas M, Marra A, Buonanno P, Iacovazzo C, Schiavone V, Servillo G. Obstetric Admissions in ICU in a Tertiary Care Center. A 5-years Retrospective Study. Indian J Crit Care Med 2019;23(5):213-219.
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Affiliation(s)
- Maria Vargas
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Annachiara Marra
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Pasquale Buonanno
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Carmine Iacovazzo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Vincenzo Schiavone
- Department of Anesthesia and Intensive Care, Pineta Grande Clinic, Caserta, Italy
| | - Giuseppe Servillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
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Zieleskiewicz L, Bouvet L, Einav S, Duclos G, Leone M. Diagnostic point‐of‐care ultrasound: applications in obstetric anaesthetic management. Anaesthesia 2018; 73:1265-1279. [DOI: 10.1111/anae.14354] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2018] [Indexed: 12/13/2022]
Affiliation(s)
- L. Zieleskiewicz
- Department of Anaesthesia and Intensive Care Medicine University Hospital of Marseille Aix Marseille university C2VN France
| | - L. Bouvet
- Department of Anaesthesia and Intensive Care Medicine Hospices Civils de Lyon Hôpital Femme Mère Enfant Bron France
| | - S. Einav
- General Intensive Care Shaare Zedek Medical Centre Hebrew University Faculty of Medicine Jerusalem Israel
| | - G. Duclos
- Department of Anaesthesia and Intensive Care Medicine University Hospital of Marseille Marseille France
| | - M. Leone
- Department of Anaesthesia and Intensive Care Medicine University Hospital of Marseille Marseille France
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Ayala Quintanilla BP, Pollock WE, McDonald SJ, Taft AJ. Impact of violence against women on severe acute maternal morbidity in the intensive care unit, including neonatal outcomes: a case-control study protocol in a tertiary healthcare facility in Lima, Peru. BMJ Open 2018; 8:e020147. [PMID: 29540421 PMCID: PMC5857655 DOI: 10.1136/bmjopen-2017-020147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 02/12/2018] [Accepted: 02/22/2018] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Preventing and reducing violence against women (VAW) and maternal mortality are Sustainable Development Goals. Worldwide, the maternal mortality ratio has fallen about 44% in the last 25 years, and for one maternal death there are many women affected by severe acute maternal morbidity (SAMM) requiring management in the intensive care unit (ICU). These women represent the most critically ill obstetric patients of the maternal morbidity spectrum and should be studied to complement the review of maternal mortality. VAW has been associated with all-cause maternal deaths, and since many women (30%) endure violence usually exerted by their intimate partners and this abuse can be severe during pregnancy, it is important to determine whether it impacts SAMM. Thus, this study aims to investigate the impact of VAW on SAMM in the ICU. METHODS AND ANALYSIS This will be a prospective case-control study undertaken in a tertiary healthcare facility in Lima-Peru, with a sample size of 109 cases (obstetric patients admitted to the ICU) and 109 controls (obstetric patients not admitted to the ICU selected by systematic random sampling). Data on social determinants, medical and obstetric characteristics, VAW, pregnancy and neonatal outcome will be collected through interviews and by extracting information from the medical records using a pretested form. Main outcome will be VAW rate and neonatal mortality rate between cases and controls. VAW will be assessed by using the WHO instrument. Binary logistic followed by stepwise multivariate regression and goodness of fit test will assess any association between VAW and SAMM. ETHICS AND DISSEMINATION Ethical approval has been granted by the La Trobe University, Melbourne-Australia and the tertiary healthcare facility in Lima-Peru. This research follows the WHO ethical and safety recommendations for research on VAW. Findings will be presented at conferences and published in peer-reviewed journals.
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Affiliation(s)
- Beatriz Paulina Ayala Quintanilla
- The Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
- Mercy Hospital for Women, Melbourne, Victoria, Australia
- Peruvian National Institute of Health, Lima, Peru
| | - Wendy E Pollock
- The Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
- Mercy Hospital for Women, Melbourne, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Susan J McDonald
- The Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
- Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Angela J Taft
- The Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
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Indications and characteristics of obstetric patients admitted to the intensive care unit: a 22-year review in a tertiary care center. Obstet Gynecol Sci 2018; 61:209-219. [PMID: 29564311 PMCID: PMC5854900 DOI: 10.5468/ogs.2018.61.2.209] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 08/21/2017] [Accepted: 08/24/2017] [Indexed: 11/08/2022] Open
Abstract
Objective Reviewing indications and characteristics of obstetric patients admitted to the intensive care unit (ICU) of a tertiary care center, comparing those patients by time period and place of delivery, and to verify clinical utility of acute physiology and chronic health evaluation (APACHE) II score in ICU-admitted women. Methods Retrospective analyses were carried out for parturients admitted to the ICU of our institution from 1994 to 2015. Clinical characteristics were compared between time period (period 1: 1994-2004; period 2: 2005-2015) and place of delivery (our institution and local hospitals). Receiver operating characteristic (ROC) curve analysis was used to evaluate the usefulness of APACHE II score to predict maternal mortality. Results During 22-year period, 176 women required ICU admission, showing the incidence of 2.2 per 1,000 deliveries. The most common reason for ICU admission was postpartum hemorrhage (56.3%), followed by hypertensive disorders (19.3%), sepsis (3.4%), and pulmonary and amniotic fluid embolism (2.3%). Period 2 showed older maternal age (32.7±4.8 vs. 30.8±4.4 years, P=0.006, higher embolization rate (26.4% vs.1.2%, P<0.001), and lower hysterectomy rate (30.8% vs. 49.4%, P=0.012). Cases from local hospitals showed significantly higher proportion of postpartum hemorrhage (84.5% vs. 42.2%, P<0.001). Overall maternal death occurred in 5.1% (9/176) including 6 direct maternal deaths. The APACHE II score showed area under the ROC curve of 0.813 (confidence interval [CI], 0.607-1.000) for prediction of maternal mortality. Conclusion The incidence of obstetric ICU admission was 2.2 per 1,000 deliveries and the most common reason was postpartum hemorrhage followed by hypertensive disorders. APACHE II score could be used to predict mortality in obstetric ICU admission.
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Chu Y, Yuan Z, Meng M, Zhou H, Wang C, Yang G, Ren H. Red blood cell distribution width as a risk factor for inhospital mortality in obstetric patients admitted to an intensive care unit: a single centre retrospective cohort study. BMJ Open 2017; 7:e012849. [PMID: 28637721 PMCID: PMC5577870 DOI: 10.1136/bmjopen-2016-012849] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Red blood cell distribution width (RDW) has been shown to predict mortality in critically ill patients. To our knowledge, whether or not RDW is associated with clinical outcomes of obstetric patients requiring critical care has not been evaluated. METHODS This was a single centre, retrospective, observational study of obstetric patients admitted to the intensive care unit (ICU). Patients were excluded from the analysis if they had known haematological diseases or recently underwent blood transfusion. Patients who died or were discharged from the ICU within 24 hours of admission were also excluded. Patient clinical characteristics at ICU admission were retrieved from the medical charts. Multiple logistic regression was used to estimate OR and 95% CI for inhospital mortality associated with RDW. The receiver operating characteristic curve was used to examine the performance of RDW, alone or in combination with the Acute Physiology and Chronic Health Evaluation II score (APACHE II), in predicting inhospital mortality. RESULTS A total of 376 patients were included in the study. The hospital mortality rate was 5.32%. A significant association was found between baseline RDW levels and hospital mortality (OR per per cent increase in RDW, 1.31; 95% CI 1.15 to 1.49). Further adjustment for haematocrit and other potential confounders did not appreciably alter the result (p<0.001). The area under the curve (AUC) for inhospital mortality based on RDW was similar to that based on the APACHE II score (0.752 vs 0.766). A combination of these two factors resulted in substantial improvement in risk prediction, with an AUC value of 0.872 (p<0.001). CONCLUSIONS The study suggests that RDW is an independent predictor for inhospital mortality among ICU admitted obstetric patients. Combining RDW and APACHE II score could significantly improve inhospital prognostic prediction among these critically ill obstetric patients.
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Affiliation(s)
- Yufeng Chu
- Department of Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Zhongshang Yuan
- Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, China
| | - Mei Meng
- Department of Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Haiyan Zhou
- Department of Medical Oncology, Shandong Tumour Hospital, Jinan, China
| | - Chunting Wang
- Department of Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Gong Yang
- Vanderbilt Epidemiology Center, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Hongsheng Ren
- Department of Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
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Abstract
Critical care in pregnancy is a field that remains unevenly researched. Although there is a body of evidence to guide many recommendations in critical care, limited research specifically addresses obstetric critical care. The purpose of this document is to review the available evidence, propose strategies for care, and highlight the need for additional research. Much of the review will, of necessity, focus on general principles of critical care, extrapolating where possible to obstetric critical care.
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Maternal and neonatal outcomes of respiratory failure during pregnancy. J Formos Med Assoc 2017; 117:413-420. [PMID: 28528140 DOI: 10.1016/j.jfma.2017.04.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 04/07/2017] [Accepted: 04/27/2017] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Obstetric patients comprise a limited portion of intensive care unit patients, but they often present with unfamiliar conditions and exhibit the potential for catastrophic deterioration. This study evaluated the maternal and neonatal outcomes of respiratory failure during pregnancy. METHODS Information on 71 patients at >25 weeks gestation in the ICU with respiratory failure was recorded between 2009 and 2013. The characteristics and outcomes of mothers and fetuses were determined through a retrospective chart review and evaluated using Student's t test, chi-square test, and Fisher's exact test. RESULTS The leading causes of respiratory failure were postpartum hemorrhage and severe preeclampsia in the obstetric causes group and pneumonia in the nonobstetric causes group during pregnancy and the peripartum period. The non-obstetric causes group exhibited a higher incidence of acute respiratory distress syndrome and renal replacement therapy as well as requiring more ventilator days. The patients in the obstetric causes group showed significant improvement after delivery in the partial pressure of arterial oxygen to the fraction of inspired oxygen and peak inspiratory pressure decrease. Both groups exhibited high incidences of neonatal respiratory distress syndrome. Neonatal complications resulting from meconium aspiration syndrome (MAS) and sepsis were more common in the non-obstetric causes group; however, neurological development impairment was more common in the obstetric causes group. CONCLUSION Obstetric cause was associated with longer ventilator free days and fewer episodes of ARDS after delivery. Neonatal complications resulting from different etiologies of respiratory failure were found to differ.
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Eadie IJ, Sheridan NF. Midwives' experiences of working in an obstetric high dependency unit: A qualitative study. Midwifery 2017; 47:1-7. [PMID: 28188998 DOI: 10.1016/j.midw.2017.01.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 01/15/2017] [Accepted: 01/19/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVES to understand the challenges experienced by midwives providing obstetric high dependency care and identify the training they perceive is needed for work in an obstetric high dependency unit. DESIGN sixteen midwives who worked in the obstetric high dependency unit participated in one of three focus groups. Focus groups lasted 60-90minutes and were conducted in the workplace and facilitated by author (IE). Data were digitally recorded, transcribed and analysed manually by author (IE), specifically using a 'codebook' model to generate codes, categories and themes. SETTING a purpose built, two-bed obstetric high dependency unit located in the delivery suite of a large, urban tertiary teaching hospital in New Zealand. FINDINGS five themes were conceptualised: Theme 1: 'high dependency care is not our bread and butter'; the midwives felt that working in the obstetric high dependency work did not constitute 'normal' midwifery work. Theme 2: 'we are family… embracing the baby and partner in HDU'; the midwives recognised that an obstetric high dependency unit enabled the mother and infant to be cared for together, was beneficial for maternal psychosocial wellbeing, and supported mother-infant bonding and breastfeeding. Theme 3: 'primum non nocere; First, do no harm'; the midwives voiced concern that they lacked the skills and training to provide obstetric high dependency care and considered this a potential risk to sick women in their care. Theme 4: 'graceful swans and headless chickens'; the midwives reported feelings of stress, anxiety, fear and of being overwhelmed by the demands of obstetric high dependency care. The more experienced midwives were able to portray calmness and poise despite lots going on beneath the surface. This was in contrast to other, often less experienced midwives, who appeared confused and less organised. Theme 5: 'please sir, can I have some more training?'; the midwives unanimously sought training in the provision of obstetric high dependency care and saw facilitation of training to be a responsibility of the hospital. KEY CONCLUSIONS midwives who are competent in obstetric high dependency care are well placed to provide holistic care to sick women within an obstetric high dependency unit. Midwives found this work challenging and identified the need for specific knowledge and skills beyond those required in the provision of care to well women. The midwives sought post-registration training in obstetric high dependency care. These findings are consistent with other studies reported in the literature. IMPLICATIONS FOR PRACTICE post-registration training must be made available to midwives providing high dependency care to sick women to ensure they have the specialised skills and knowledge for practice. Responsibility to facilitate training rests with hospitals providing this service.
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Affiliation(s)
- Isabelle J Eadie
- School of Nursing, Faculty of Medical & Health Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
| | - Nicolette F Sheridan
- School of Nursing, Faculty of Medical & Health Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
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Ayala Quintanilla BP, Taft A, McDonald S, Pollock W, Roque Henriquez JC. Social determinants and maternal exposure to intimate partner violence of obstetric patients with severe maternal morbidity in the intensive care unit: a systematic review protocol. BMJ Open 2016; 6:e013270. [PMID: 27895065 PMCID: PMC5168548 DOI: 10.1136/bmjopen-2016-013270] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 11/02/2016] [Accepted: 11/07/2016] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Maternal mortality is a potentially preventable public health issue. Maternal morbidity is increasingly of interest to aid the reduction of maternal mortality. Obstetric patients admitted to the intensive care unit (ICU) are an important part of the global burden of maternal morbidity. Social determinants influence health outcomes of pregnant women. Additionally, intimate partner violence has a great negative impact on women's health and pregnancy outcome. However, little is known about the contextual and social aspects of obstetric patients treated in the ICU. This study aimed to conduct a systematic review of the social determinants and exposure to intimate partner violence of obstetric patients admitted to an ICU. METHODS AND ANALYSIS A systematic search will be conducted in MEDLINE, CINAHL, ProQuest, LILACS and SciELO from 2000 to 2016. Studies published in English and Spanish will be identified in relation to data reporting on social determinants of health and/or exposure to intimate partner violence of obstetric women, treated in the ICU during pregnancy, childbirth or within 42 days of the end of pregnancy. Two reviewers will independently screen for study eligibility and data extraction. Risk of bias and assessment of the quality of the included studies will be performed by using the Critical Appraisal Skills Programme (CASP) checklist. Data will be analysed and summarised using a narrative description of the available evidence across studies. This systematic review protocol will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines. ETHICS AND DISSEMINATION Since this systematic review will be based on published studies, ethical approval is not required. Findings will be presented at La Trobe University, in Conferences and Congresses, and published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER CRD42016037492.
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Affiliation(s)
- Beatriz Paulina Ayala Quintanilla
- The Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
- Mercy Hospital for Women, Melbourne, Victoria, Australia
- Peruvian National Institute of Health, Lima, Peru
| | - Angela Taft
- The Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Susan McDonald
- The Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
- Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Wendy Pollock
- The Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
- Mercy Hospital for Women, Melbourne, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
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Baek MS, Son J, Huh JW, Lim CM, Koh Y, Won HS, Shim JY, Hong SB. Medical emergency team may reduce obstetric intensive care unit admissions. J Obstet Gynaecol Res 2016; 43:106-113. [PMID: 27762469 DOI: 10.1111/jog.13177] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/18/2016] [Accepted: 08/16/2016] [Indexed: 11/26/2022]
Abstract
AIM Some recent studies have reported that early intervention by a medical emergency team (MET) for clinical deterioration before intensive care unit (ICU) admission was associated with a survival benefit in critically ill cancer patients. We hypothesized that early MET intervention for an obstetric crisis in the general wards would be related to favorable outcomes in critically ill obstetric patients. METHODS Data of obstetric patients who were managed by a MET were collected retrospectively from 1 March 2008 to 30 April 2015. A total of 69 obstetric patients were enrolled. Among them, 48 (69.6%) were treated successfully in the general wards and 21 (30.4%) were transferred to the ICU. RESULTS Major causes of MET activation were pulmonary edema (n = 23, 33.3%), hypovolemic shock (n = 19, 27.5%), and septic shock (n = 8, 11.6%). Compared with the patients treated in the general ward, the patients transferred to the ICU had significantly higher severity of illness score. Sequential Organ Failure Assessment score was the most useful for prediction of ICU admission of obstetric patients (AUC, 0.810, P < 0.001), and the ideal cut-off was 4 (sensitivity, 81%; specificity, 60%). During the study period, in-hospital mortality of the obstetric patients was 2.9% (2/69). CONCLUSION After MET activation many obstetric patients could be successfully treated in the general wards without mortality. Therefore, MET may reduce ICU admissions in critically ill obstetric patients.
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Affiliation(s)
- Moon Seong Baek
- Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Jeongsuk Son
- Medical Emergency Team, Asan Medical Center, Seoul, South Korea
| | - Jin Won Huh
- Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Chae-Man Lim
- Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Younsuck Koh
- Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Hye-Sung Won
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Jae-Yoon Shim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Sang-Bum Hong
- Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
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Evaluation of maternal early obstetric warning system (MEOWS chart) as a predictor of obstetric morbidity: a prospective observational study. Eur J Obstet Gynecol Reprod Biol 2016; 207:11-17. [PMID: 27792988 DOI: 10.1016/j.ejogrb.2016.09.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 09/09/2016] [Accepted: 09/13/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Maternal Early Obstetric Warning System (MEOWS) chart adopted from CEMACH 2003-2005 report is based on the principle that abnormalities in physiological parameters precede critical illness. The 'track and trigger' of physiological parameters on this chart can aid in recognition of maternal morbidity at an early stage, ultimately halting the cascade of severe maternal morbidity and mortality. The objectives of our study were to evaluate MEOWS chart as a bedside screening tool for predicting obstetric morbidity and to correlate each physiological parameter individually with obstetric morbidity. STUDY DESIGN It was a prospective observational study conducted in labour wards of Guru Teg Bahadur Hospital, Delhi, India from October 2012 to April 2014. Physiological parameters of 1065 study subjects (including pregnant women in labour >28 weeks of gestation and postpartum women up to 6 weeks after delivery) were recorded on MEOWS chart. A trigger was defined as a single markedly abnormal observation (red trigger) or the combination of two simultaneously mildly abnormal observation (two yellow triggers). Based on outcome at time of discharge, Category 1 (normal and recovered without morbidity) and Category 2 (recovered with morbidity or mortality) were defined. Chi-square and Fischer's exact test were used for comparison between two groups. Performance of MEOWS chart was evaluated using Exact's method. Relative risk of morbidity (odd's ratio) and 95% confidence interval was calculated for individual parameter. p<0.05 was considered as significant. RESULTS Two-hundred and eighty-four (26.6%) women triggered to abnormal zones on these charts. One-hundred and seventy-seven (16.61%) fulfilled the criteria for obstetric morbidity. MEOWS chart was 86.4% sensitive, 85.2% specific with a positive and negative predictive value of 53.8% and 96.9% respectively for prediction of obstetric morbidity. Individual parameters of MEOWS chart also had a significant correlation (p<0.05) with obstetric morbidity. CONCLUSIONS MEOWS chart emerged as a useful bedside screening tool for prediction of obstetric morbidity and should be used routinely in every obstetric unit. Strict monitoring and documentation of all the vital parameters should be fundamental part of any patient's assessment to pick up acute illness at very early stage and to make a difference in final outcome.
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Management of Acute Postpartum Hemorrhage in Senegal. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2016. [DOI: 10.1007/s13669-016-0166-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Zieleskiewicz L, Chantry A, Duclos G, Bourgoin A, Mignon A, Deneux-Tharaux C, Leone M. Intensive care and pregnancy: Epidemiology and general principles of management of obstetrics ICU patients during pregnancy. Anaesth Crit Care Pain Med 2016; 35 Suppl 1:S51-S57. [PMID: 27386763 DOI: 10.1016/j.accpm.2016.06.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In developed countries, the rate of obstetric ICU admissions (admission during pregnancy or the postpartum period) is between 0.5 and 4 per 1000 deliveries and the overall case-fatality rate is about 2%. The most two common causes of obstetric ICU admissions concerned direct obstetric pathologies: obstetric hemorrhage and hypertensive disorders of pregnancy. This review summarized the principles of management of critically ill pregnant patient. Its imply taking care of two patients in the same time. A coordinated multidisciplinary team including intensivists, anesthesiologists, obstetricians, pediatricians and pharmacists is therefore necessary. This team must work effectively together with regular staff aiming to evaluate daily the need to maintain the patient in intensive care unit or to prompt delivery. Keeping mother and baby together and fetal well-being must be balanced with the need of specialized advanced life support for the mother. The maternal physiological changes imply various consequences on management. The uterus aorto-caval compression implies tilting left the parturient. In case of cardiac arrest, uterus displacement and urgent cesarean delivery are needed. The high risk of aspiration and difficult tracheal intubation must be anticipated. Even during acute respiratory distress syndrome, hypoxemia and permissive hypercapnia must be avoided due to their negative impact on the fetus. Careful analysis of the benefit-risk ratio is needed before all drug administration. Streptococcal toxic shock syndrome and perineal fasciitis must be feared and a high level of suspicion of sepsis must be maintained. Finally the potential benefits of an ultrasound-based management are detailed.
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Affiliation(s)
- Laurent Zieleskiewicz
- Service d'anesthésie et de réanimation, Aix Marseille université, hôpital Nord, Assistance publique-Hôpitaux de Marseille, chemin des Bourrely, 13015 Marseille, France.
| | - Anne Chantry
- Inserm UMR 1153, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), centre de recherche épidémiologie et statistique Sorbonne Paris Cité, DHU risques et grossesse, université Paris Descartes, 75014 Paris, France; École de sages-femmes Baudelocque, université Paris Descartes, DHU Risques et grossesse, Assistance publique-Hôpitaux de Paris, 75014 Paris, France
| | - Gary Duclos
- Service d'anesthésie et de réanimation, Aix Marseille université, hôpital Nord, Assistance publique-Hôpitaux de Marseille, chemin des Bourrely, 13015 Marseille, France
| | - Aurelie Bourgoin
- Service d'anesthésie et de réanimation, Aix Marseille université, hôpital Nord, Assistance publique-Hôpitaux de Marseille, chemin des Bourrely, 13015 Marseille, France
| | - Alexandre Mignon
- Service d'anesthésie et de réanimation, Aix Marseille université, hôpital Nord, Assistance publique-Hôpitaux de Marseille, chemin des Bourrely, 13015 Marseille, France
| | - Catherine Deneux-Tharaux
- Inserm UMR 1153, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), centre de recherche épidémiologie et statistique Sorbonne Paris Cité, DHU risques et grossesse, université Paris Descartes, 75014 Paris, France
| | - Marc Leone
- Service d'anesthésie et de réanimation, Aix Marseille université, hôpital Nord, Assistance publique-Hôpitaux de Marseille, chemin des Bourrely, 13015 Marseille, France
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Guntupalli KK, Karnad DR, Bandi V, Hall N, Belfort M. Critical Illness in Pregnancy: Part II: Common Medical Conditions Complicating Pregnancy and Puerperium. Chest 2016; 148:1333-1345. [PMID: 26020727 DOI: 10.1378/chest.14-2365] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The first of this two-part series on critical illness in pregnancy dealt with obstetric disorders. In Part II, medical conditions that commonly affect pregnant women or worsen during pregnancy are discussed. ARDS occurs more frequently in pregnancy. Strategies commonly used in nonpregnant patients, including permissive hypercapnia, limits for plateau pressure, and prone positioning, may not be acceptable, especially in late pregnancy. Genital tract infections unique to pregnancy include chorioamnionitis, group A streptococcal infection causing toxic shock syndrome, and polymicrobial infection with streptococci, staphylococci, and Clostridium perfringens causing necrotizing vulvitis or fasciitis. Pregnancy predisposes to VTE; D-dimer levels have low specificity in pregnancy. A ventilation-perfusion scan is preferred over CT pulmonary angiography in some situations to reduce radiation to the mother's breasts. Low-molecular-weight or unfractionated heparins form the mainstay of treatment; vitamin K antagonists, oral factor Xa inhibitors, and direct thrombin inhibitors are not recommended in pregnancy. The physiologic hyperdynamic circulation in pregnancy worsens many cardiovascular disorders. It increases risk of pulmonary edema or arrhythmias in mitral stenosis, heart failure in pulmonary hypertension or aortic stenosis, aortic dissection in Marfan syndrome, or valve thrombosis in mechanical heart valves. Common neurologic problems in pregnancy include seizures, altered mental status, visual symptoms, and strokes. Other common conditions discussed are aspiration of gastric contents, OSA, thyroid disorders, diabetic ketoacidosis, and cardiopulmonary arrest in pregnancy. Studies confined to pregnant women are available for only a few of these conditions. We have, therefore, reviewed pregnancy-specific adjustments in the management of these disorders.
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Affiliation(s)
- Kalpalatha K Guntupalli
- Section of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, TX.
| | - Dilip R Karnad
- Department of Critical Care, Jupiter Hospital, Thane, India
| | - Venkata Bandi
- Section of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, TX
| | - Nicole Hall
- Department of Medicine, the Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX; Department of Obstetrics and Gynecology, Texas Children's Hospital Pavilion for Women, Houston, TX
| | - Michael Belfort
- Department of Medicine, the Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX; Department of Surgery, Baylor College of Medicine, Houston, TX; Department of Anesthesiology, Baylor College of Medicine, Houston, TX; Department of Obstetrics and Gynecology, Texas Children's Hospital Pavilion for Women, Houston, TX
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Abstract
Heart disease is a common cause of morbidity and mortality during pregnancy. Symptoms and signs of heart failure in a pregnant woman are an indication for urgent assessment to establish a diagnosis and appropriate management. This is best accomplished through a multidisciplinary approach in which both cardiologists and obstetricians need to participate in order to provide expert counselling and care in pursuit of safe motherhood. Congenital heart disease, although common, once corrected is an unusual source of complications, which are more likely to develop as a consequence of ventricular failure, pulmonary hypertension and aortic arch disease. Rheumatic valvular heart disease is a challenge because of the need for anticoagulation during pregnancy and the risk of sepsis associated with childbirth. This review outlines a contemporary approach to heart failure presenting during pregnancy.
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Affiliation(s)
- John Anthony
- Division of Obstetrics and Gynaecology Groote Schuur Hospital, University of Cape Town,Cape Town, South Africa
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town,Cape Town, South Africa.,Soweto Cardiovascular Research Group University of theWitwatersrand, South Africa
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Jain S, Guleria K, Suneja A, Vaid NB, Ahuja S. Use of the Sequential Organ Failure Assessment score for evaluating outcome among obstetric patients admitted to the intensive care unit. Int J Gynaecol Obstet 2015; 132:332-6. [PMID: 26792141 DOI: 10.1016/j.ijgo.2015.08.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Revised: 08/06/2015] [Accepted: 11/16/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the prognostic value of the Sequential Organ Failure Assessment (SOFA) score among obstetric patients admitted to the intensive care unit (ICU). METHODS A prospective study was conducted among 90 consecutive obstetric patients who were admitted to the ICU of Guru Teg Bahadur Hospital, Delhi, India, between October 6, 2010, and December 25, 2011. Maximum SOFA score was calculated for each of the six organ systems. Receiver operating characteristic curves were used to determine critical cutoff values for total, maximum total, and mean total SOFA scores at various time points. RESULTS Total SOFA score at admission displayed an area under the curve (AUC) of 0.949, a cutoff value of at least 8.5, sensitivity of 86.7%, and specificity of 90.0%. Maximum total SOFA score had an AUC of 0.980, a cutoff value of at least 10.0, sensitivity of 96.7%, and specificity of 90.0%. Mean total SOFA score had an AUC of 0.997, a cutoff value of at least 9.0, sensitivity of 96.7%, and specificity of 96.7%. CONCLUSION In terms of discriminatory power for predicting mortality among obstetric patients admitted to the ICU, total SOFA score at admission was the most relevant, simple, and accurate measure.
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Affiliation(s)
- Shruti Jain
- Department of Obstetrics and Gynaecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India.
| | - Kiran Guleria
- Department of Obstetrics and Gynaecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Amita Suneja
- Department of Obstetrics and Gynaecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Neelam B Vaid
- Department of Obstetrics and Gynaecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Sharmila Ahuja
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
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Guntupalli KK, Hall N, Karnad DR, Bandi V, Belfort M. Critical Illness in Pregnancy. Chest 2015; 148:1093-1104. [DOI: 10.1378/chest.14-1998] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Pizzagalli F, Agasse J, Marpeau L. [Carbetocin versus Oxytocin during caesarean section for preventing postpartum haemorrhage]. ACTA ACUST UNITED AC 2015; 43:356-60. [PMID: 25892107 DOI: 10.1016/j.gyobfe.2015.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 03/04/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of the study was to compare the effectiveness of Carbetocin versus Oxyotcin during caesarean section for preventing postpartum haemorrhage. METHODS Prospective observational study (before/after design). Five hundred and forty patients who received an injection of Oxytocin were compared to 262 patients with single injection of 100 micrograms of Carbetocin. The primary outcome was to compare the differential hematocrit level between pre- and postoperative blood samples. The secondary outcome was to compare differential hemoglobin level and the use of complementary therapies for postpartum haemorrhage. RESULTS We did not find any difference between the Oxytocin and Carbetocin groups on differential hematocrit level. There was no difference between the groups regarding the use of additionnal therapies (Sulproston injections, blood transfusions and surgery methods). The rate of postpartum haemorrhage was similar in the two groups (18.7% vs 21.6%; P=0.33). We found a lower percentage of patients with differential of hemoglobin level between 2 g/dL and 4 g/dL in the Carbetocin group (6.5% vs 15.6%, P<0.001). The proportion of patients requiring intravenous iron administration was significantly lower in the Carbetocin group (6.8% vs 13.8%, P=0.0036) CONCLUSION: According to the primary outcome, there is no difference in effectiveness between carbetocin and oxytocin. Carbetocin seems to reduce the need for postoperative intravenous iron injection.
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Affiliation(s)
- F Pizzagalli
- Clinique gynécologique et obstétricale, centre hospitalier universitaire Charles-Nicolle, 1, rue de Germont, 76031 Rouen, France.
| | - J Agasse
- Clinique gynécologique et obstétricale, centre hospitalier universitaire Charles-Nicolle, 1, rue de Germont, 76031 Rouen, France
| | - L Marpeau
- Clinique gynécologique et obstétricale, centre hospitalier universitaire Charles-Nicolle, 1, rue de Germont, 76031 Rouen, France
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Postpartum acute renal failure: a multicenter study of risk factors in patients admitted to ICU. Ann Intensive Care 2014; 4:36. [PMID: 25593752 PMCID: PMC4273687 DOI: 10.1186/s13613-014-0036-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 11/04/2014] [Indexed: 12/27/2022] Open
Abstract
Background Even in developed countries, severe specific pregnancy complications may occur in the immediate postpartum period and require admission to the ICU. The characteristics and risk factors of acute renal failure (ARF) induced by these complications and their treatments are not well known. Methods We performed a retrospective multicenter study in three intensive care departments linked to level III maternity wards in the north of France. All patients admitted to ICU for postpartum complications over a 5-year period (2008 to 2012) were included. Clinical and biological data, delivery characteristics, type of complications, and treatments were compared by univariate and multivariate analyses according to the occurrence and severity of ARF. Results One hundred eighty-two patients admitted to ICU for postpartum complications were included in the study. Sixty-eight patients (37%) developed an ARF: 49 with a low or medium severity and 19 with a severe ARF requiring renal replacement therapy. Hemolysis, elevated liver enzyme, and low platelet count (HELLP) syndrome on its own (p = 0.047) or combined with postpartum haemorrhage (p = 0.003), previous treatment by hyperoncotic albumin infusion (p = 0.001) and blockade of fibrinolysis by tranexamic acid (p = 0.03), was associated with secondary ARF. By multivariate analysis, the only independent factors were the association of HELLP syndrome with postpartum haemorrhage and the use of hyperoncotic albumin infusion. Conclusions HELLP syndrome associated with postpartum haemorrhage induces a high risk of ARF in the complicated postpartum setting. A particular attention should be given to treatments that could worsen the kidney function in that situation.
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Paternina-Caicedo AJ, Rojas-Suarez JA, Dueñas-Castel C, Miranda-Quintero JE, Bourjeily G. Mortality risk prediction with an updated Acute Physiology and Chronic Health Evaluation II score in critically ill obstetric patients: a cohort study. J Intensive Care Med 2013; 30:97-102. [PMID: 24004907 DOI: 10.1177/0885066613502450] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Acute Physiology and Chronic Health Evaluation II (APACHE II) score has shown low prognostic ability to predict death in the obstetric population. The objective of this study was to evaluate whether an updated form of the APACHE II score would perform better in predicting mortality in critically ill obstetric patients. METHODS A retrospective cohort study of pregnant and postpartum women (up to 42 days after delivery) who were admitted to the intensive care unit (ICU) was carried out at an ICU at Rafael Calvo Maternity Hospital, a large obstetric hospital in Colombia. Data were collected on consecutive obstetric patients admitted to the ICU between 2006 and 2011. A discrimination and calibration analysis was completed on the original APACHE II score and an updated APACHE II score. RESULTS Data were collected on a total of 726 obstetric patients. The area under the receiver-operating characteristic curve was 0.86 (95% confidence interval [95% CI], 0.80-0.93) for both APACHE II and the updated APACHE II scores. Mortality ratio for the original APACHE II was 0.30 (95% CI, 0.19-0.41) and 0.85 (95% CI, 0.56-1.24) for the updated APACHE II. CONCLUSIONS The APACHE II overestimates mortality in the sample population. The updated APACHE II model predicts mortality more accurately in the obstetric population. This formula may be useful in adapting the existing APACHE II to current mortality risk in obstetric critical care populations.
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Affiliation(s)
- Angel J Paternina-Caicedo
- Grupo de Investigación en Cuidados intensivos y Obstetricia, GRICIO, Universidad de Cartagena, Cartagena, Colombia
| | - José A Rojas-Suarez
- Grupo de Investigación en Cuidados intensivos y Obstetricia, GRICIO, Universidad de Cartagena, Cartagena, Colombia Unidad de Cuidados Intensivos, Gestion Salud S.A. at Clinica Maternidad Rafael Calvo, Cartagena, Colombia
| | - Carmelo Dueñas-Castel
- Grupo de Investigación en Cuidados intensivos y Obstetricia, GRICIO, Universidad de Cartagena, Cartagena, Colombia Unidad de Cuidados Intensivos, Gestion Salud S.A. at Clinica Maternidad Rafael Calvo, Cartagena, Colombia
| | - Jezid E Miranda-Quintero
- Grupo de Investigación en Cuidados intensivos y Obstetricia, GRICIO, Universidad de Cartagena, Cartagena, Colombia
| | - Ghada Bourjeily
- Department of Medicine, Pulmonary and Critical Care Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, USA
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Ramachandra Bhat PB, Navada MH, Rao SV, Nagarathna G. Evaluation of obstetric admissions to intensive care unit of a tertiary referral center in coastal India. Indian J Crit Care Med 2013; 17:34-7. [PMID: 23833474 PMCID: PMC3701395 DOI: 10.4103/0972-5229.112156] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background and Aim: To evaluate the occurrence, indications, course, interventions, and outcome of obstetric patients admitted to the intensive care unit (ICU). Design: Retrospective study. Setting: ICU of a Medical College Hospital. Materials and Methods: The data collected were age, parity, obstetric status, primary diagnosis, interventions, and outcome of obstetric patients admitted to the ICU from Jan 2005 to June 2011. Results: Total deliveries were 16,804 in 6.5 years. Obstetric admissions to the ICU were (n = 65) which constitutes 0.39% of deliveries. Majority of the admissions were in the postpartum period (n = 46, 70.8%). The two common indications for admission were obstetric hemorrhage (n = 18, 27.7%) and pregnancy related hypertension with its complications (n = 17, 26.2%). The most common intervention was artificial ventilation (n = 41, 63%). The mortality among obstetric admissions in the ICU was (33.8% (22/65)). The patients appropriate for High Dependency Unit (HDU) care was (32.3% (21/65)). The statistical analysis was done by fractional percentage and Chi-square test. Conclusions: Hemorrhage and pregnancy-related hypertension with its complications are the two common indications for ICU admissions. The need for a HDU should be considered.
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Affiliation(s)
- John Clift
- Consultant Intensivist and Obstetric Anaesthetist, Sandwell and West Birmingham NHS Trust
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Devabhaktuni P, Samavedam S, Thota GVS, Pusala SV, Velaga K, Bommakanti L, Nawinne M, Thomas P. Clinical profile and outcome of obstetric ICU patients. APACHE II, SOFA, SAPS II and MPM scoring systems for prediction of prognosis. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/ojog.2013.39a006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Zieleskiewicz L, Lagier D, Contargyris C, Bourgoin A, Gavage L, Martin C, Leone M. Lung ultrasound-guided management of acute breathlessness during pregnancy. Anaesthesia 2012; 68:97-101. [PMID: 23088788 DOI: 10.1111/anae.12037] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Lung ultrasonography is a standard tool in the intensive care unit and in emergency medicine, but has not been described in the particular setting of the labour ward. During pregnancy, acute respiratory failure and pulmonary oedema are not uncommon life-threatening events. We present two case reports outlining the potential of lung ultrasonography in parturients. In case 1, lung ultrasonography allowed early diagnosis and treatment of acute dyspnoea in a parturient admitted for suspected asthma exacerbation. Lung ultrasonography revealed a 'B-pattern' of vertical lines radiating into the lung tissue, indicating severe pulmonary oedema complicating previously undiagnosed pre-eclampsia. In case 2, a pre-eclamptic patient was managed with combined transthoracic echocardiography and lung ultrasonography. The accuracy of lung ultrasonography in detecting interstitial oedema at a pre-clinical stage allowed adequate fluid resuscitation in this patient who had a high risk of alveolar pulmonary oedema. We believe that these cases strongly support the prospective validation of lung ultrasound for management of lung disorders in pregnant women.
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Affiliation(s)
- L Zieleskiewicz
- Department of Anaesthesia and Intensive Care Medicine, University Hospital of Marseille, Marseille, France.
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Abstract
Obstetrical critical care has not been able to achieve the same level of peaks in developing nations like India, as in the western countries. Numerous factors, including clinical and economical, have played a major role in widening the gap of quality care delivery in severely ill obstetric patients, between the two extreme worlds. Moreover, this wide gap can be, to a large extent, attributable to the lower literacy rates, paucity of research in obstetrical critical care, poverty, lack of awareness, and the sociocultural and behavioral factors prevalent in these developing nations. The most common indication for Intensive Care Unit (ICU) admission of such patients throughout the world is hemorrhage, both antepartum and postpartum. Hypertensive disorders, pre-eclampsia, and its related complications are also major contributory factors for such admissions. The pattern of the disease necessitating such admissions influences maternal mortality to a great extent. The present article reviews the most common indications of obstetrical admissions to the ICU, the challenges and obstacles in the treatment of severely ill obstetric patients, their possible outcome in the developing nations, room for improvement, and the need for a change in the system for better delivery of critical care obstetrical services.
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Affiliation(s)
- Sukhwinder Kaur Bajwa
- Department of Obstetrics and Gynaecology, Gian Sagar Medical College and Hospital, Ram Nagar, Banur, Punjab, India
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37
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Rios FG, Risso-Vázquez A, Alvarez J, Vinzio M, Falbo P, Rondinelli N, Bienzobas DH. Clinical characteristics and outcomes of obstetric patients admitted to the intensive care unit. Int J Gynaecol Obstet 2012; 119:136-40. [DOI: 10.1016/j.ijgo.2012.05.039] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Revised: 05/15/2012] [Accepted: 07/20/2012] [Indexed: 10/28/2022]
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Andrade Lima Coêlho MD, Katz L, Coutinho I, Hofmann A, Miranda L, Amorim M. Perfil de mulheres admitidas em uma UTI obstétrica por causas não obstétricas. Rev Assoc Med Bras (1992) 2012. [DOI: 10.1590/s0104-42302012000200011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Oliveira-Neto A, Parpinelli MA, Cecatti JG, Souza JP, Sousa MH. Sequential organ failure assessment score for evaluating organ failure and outcome of severe maternal morbidity in obstetric intensive care. ScientificWorldJournal 2012; 2012:172145. [PMID: 22454600 PMCID: PMC3289867 DOI: 10.1100/2012/172145] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 10/31/2011] [Indexed: 01/31/2023] Open
Abstract
Objective. To evaluate the performance of Sequential Organ Failure Assessment (SOFA) score in cases of severe maternal morbidity (SMM). Design. Retrospective study of diagnostic validation. Setting. An obstetric intensive care unit (ICU) in Brazil. Population. 673 women with SMM. Main Outcome Measures. mortality and SOFA score. Methods. Organ failure was evaluated according to maximum score for each one of its six components. The total maximum SOFA score was calculated using the poorest result of each component, reflecting the maximum degree of alteration in systemic organ function. Results. highest total maximum SOFA score was associated with mortality, 12.06 ± 5.47 for women who died and 1.87 ± 2.56 for survivors. There was also a significant correlation between the number of failing organs and maternal mortality, ranging from 0.2% (no failure) to 85.7% (≥3 organs). Analysis of the area under the receiver operating characteristic (ROC) curve (AUC) confirmed the excellent performance of total maximum SOFA score for cases of SMM (AUC = 0.958). Conclusions. Total maximum SOFA score proved to be an effective tool for evaluating severity and estimating prognosis in cases of SMM. Maximum SOFA score may be used to conceptually define and stratify the degree of severity in cases of SMM.
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Affiliation(s)
- Antonio Oliveira-Neto
- Intensive Care Unit, Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
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41
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Maternal sepsis during pregnancy or the postpartum period requiring intensive care admission. Int J Obstet Anesth 2012; 21:51-5. [DOI: 10.1016/j.ijoa.2011.10.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 10/04/2011] [Accepted: 10/24/2011] [Indexed: 11/17/2022]
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Honiden S, Abdel-Razeq SS, Siegel MD. The management of the critically ill obstetric patient. J Intensive Care Med 2011; 28:93-106. [PMID: 21841145 DOI: 10.1177/0885066611411408] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Hypertensive disorders, postpartum hemorrhage, and sepsis are the most common indications for intensive care unit admission among obstetric patients. In general, ICU mortality is low, and better than would be predicted using available mortality prediction tools. Provision of care to this special population requires an intimate understanding of physiologic changes that occur during pregnancy. Clinicians must be aware of the way various diagnostic and treatment choices can affect the mother and fetus. Most clinically necessary radiographic tests can be safely performed and fall under the maternal radiation exposure limit of less than 0.05 Gray (Gy). Careful attention must be paid to acid-base status, oxygenation, and ventilation when faced with respiratory failure necessitating intubation. Cesarean delivery can be justified after 4 minutes of cardiac arrest and may improve fetal and maternal outcomes. The treatment of obstetric patients in the ICU introduces complexities and challenges that may be unfamiliar to many critical care physicians; teamwork and communication with obstetricians is crucial.
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Affiliation(s)
- Shyoko Honiden
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, Yale University School of Medicine, New Haven, CT 06520, USA.
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43
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Ducarme G, Bonne S, Khater C, Ceccaldi PF, Poujade O, Luton D. [Acute non-obstetrical diseases during pregnancy and role of the obstetrician]. Presse Med 2011; 41:125-33. [PMID: 21632203 DOI: 10.1016/j.lpm.2011.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 03/17/2011] [Accepted: 04/07/2011] [Indexed: 10/14/2022] Open
Abstract
The management of a pregnant woman with an acute non-obstetrical disease must be made in narrow collaboration with an obstetrician. This one must be warned from the beginning of the care of the patient. In a pregnant woman, any acute medical, surgical or traumatic non-obstetrical disease can have obstetrical consequences. The diagnostic and therapeutic management of an acute non-obstetrical disease can have iatrogenic consequences during pregnancy. The most often described risks are early pregnancy loss, intra-uterine fetal death, placenta abruption, direct fetal hurts, preterm labor, prematurity and its complications. Obstetrical complications can induce maternal and neonatal life-threatening risks. Simple and easily accessible examinations in emergency allow detecting the obstetrical consequences of an acute non-obstetrical disease. During the management of an acute non-obstetrical disease in a pregnant woman, the induced obstetrical consequence of the disease can require emergency action of the obstetrician in conditions associated with maternal life-threatening risk. During the management of an acute non-obstetrical disease in a pregnant woman, once the mother condition was stabilized, the obstetrician had to estimate the fetal consequences and to adapt his or her therapeutic attitude. He or she sets up the fetal and placental surveillance adapted to the obstetrical risks and decides on the duration of this surveillance.
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Affiliation(s)
- Guillaume Ducarme
- Université Paris VII, Assistance publique-Hôpitaux de Paris (AP-HP), hôpital Beaujon, département de gynécologie obstétrique, 100, boulevard du Général-Leclerc, 92110 Clichy, France.
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Munnur U, Bandi V, Guntupalli KK. Management principles of the critically ill obstetric patient. Clin Chest Med 2011; 32:53-60. [PMID: 21277449 DOI: 10.1016/j.ccm.2010.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The goals in management of critically ill obstetric patients involve intensive monitoring and physiologic support for patients with life-threatening but potentially reversible conditions. Management principles of the mother should also take the fetus and gestational age into consideration. The most common reasons for intensive care admissions (ICU) in the United States and United Kingdom are hypertensive disorders, sepsis, and hemorrhage. The critically ill obstetric patient poses several challenges to the clinicians involved in her care, because of the anatomic and physiologic changes that take place during pregnancy.
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Affiliation(s)
- Uma Munnur
- Department of Anesthesiology, Baylor College of Medicine, 1709 Dryden Road, Suite 1700, Houston, TX 77030, USA.
| | - Venkata Bandi
- Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, 1709 Dryden Road, 9th Floor, Houston, TX 77030, USA
| | - Kalpalatha K Guntupalli
- Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, 1709 Dryden Road, 9th Floor, Houston, TX 77030, USA
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Campbell TA, Sanson TG. Cardiac arrest and pregnancy. J Emerg Trauma Shock 2009; 2:34-42. [PMID: 19561954 PMCID: PMC2700584 DOI: 10.4103/0974-2700.43586] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Accepted: 08/10/2008] [Indexed: 12/18/2022] Open
Abstract
Cardiopulmonary arrest in pregnancy is rare occurring in 1 in 30,000 pregnancies. When it does occur, it is important for a clinician to be familiar with the features peculiar to the pregnant state. Knowledge of the anatomic and physiologic changes of pregnancy is helpful in the treatment and diagnosis. Although the main focus should be on the mother, it should not be forgotten that there is another potential life at stake. Resuscitation of the mother is performed in the same manner as in any other patient, except for a few minor adjustments because of the changes of pregnancy. The specialties of obstetrics and neonatology should be involved early in the process to ensure appropriate treatment of both mother and the newborn. This article will explore the changes that occur in pregnancy and their impact on treatment. The common causes of maternal cardiac arrest will be discussed briefly.
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Affiliation(s)
- Tabitha A Campbell
- University of South Florida–Emergency Medicine, Tampa General Hospital, USA
| | - Tracy G Sanson
- Department of Emergency Medicine, Tampa General Hospital, USA
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46
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Fetal outcomes of critically ill pregnant women admitted to the intensive care unit for nonobstetric causes. Crit Care Med 2008; 36:2746-51. [PMID: 18828192 DOI: 10.1097/ccm.0b013e318186b615] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The outcome of the fetus in critically ill mothers has been briefly reported as a part of descriptive studies focusing on maternal risk factors for admission to the intensive care unit. We evaluated the risk factors for adverse fetal outcomes in critically ill pregnant women admitted to the intensive care unit for nonobstetrical reasons. DESIGN Retrospective cohort study of all critically ill pregnant patients >18 yr; admitted to four (medical, surgical, trauma, and mixed medical-surgical) intensive care units at the Mayo Clinic in Rochester, MN; during the period of January 1995 to December 2005. Only pregnant women admitted to the intensive care unit in the antepartum period for nonobstetrical indications were included. Main predictors for fetal outcomes included: maternal comorbidities, obstetrical history, intensive care unit interventions, and intensive care unit complications. Fetal outcomes were defined as spontaneous abortions, neonatal mortality, fetal deaths, admission to the neonatal intensive care unit, neonatal intensive care unit length of stay, and neonatal intensive care unit complications. RESULTS A total of 153 adult women (>18 yr) with a diagnosis of pregnancy were admitted to the intensive care unit, of whom 93 pregnant women met the inclusion criteria. Median maternal age was 26 yr (interquartile range 22-33) and median gestational age was 25 wk (interquartile range 8-33). The median maternal Acute Physiologic and Chronic Health Evaluation III score was 27 (interquartile range 17-38). There were 32 fetal losses; 18 were spontaneous abortions and 14 were fetal deaths. Ten neonates required neonatal intensive care unit admission, five for respiratory distress syndrome; and only one neonate died. The median neonatal intensive care unit length of stay was 34 days (interquartile range 15-87). After multivariable logistic regression analysis, the risk factors associated with fetal loss were: presence of maternal shock, odds ratio 6.85 (95% confidence interval 1.16-58, p = 0.04); maternal transfusion of blood products, odds ratio 7.24 (95% confidence interval 1.4-49, p = 0.02); and gestational age, odds ratio 1.2 for every gestational week below 37 wk (95% confidence interval 1.1-1.3, p < 0.001). CONCLUSIONS Nonobstetrical critical illness in pregnant women significantly affects fetal and neonatal outcomes. Maternal shock, maternal requirement of allogenic blood product transfusion and lower gestational age were associated with an increased risk of fetal loss.
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[Obstetric patients requiring admission to the intensive care unit]. ENFERMERIA CLINICA 2008; 18:284. [PMID: 18840341 DOI: 10.1016/s1130-8621(08)72391-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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50
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Gonçalves Marcos IAC. [Pregnancy and lungs]. REVISTA PORTUGUESA DE PNEUMOLOGIA 2007; 13:213-37. [PMID: 17492234 DOI: 10.1016/s0873-2159(15)30345-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Respiratory pathology can be relatively frequent during pregnancy. One third of pregnant woman may experience worsening of their asthma condition. Pulmonary tromboembolism is 5 times more frequent in pregnancy. Bacterial, viral and fungal pneumonias are badly tolerated during pregnancy, provoking mother-foetal morbidity, respiratory insufficiency, low born-weight or prematurity. Non-treated tuberculosis may increase maternal mortality and preterm birth by 4 and 9 times respectively. Pregnancy is counter-indicated in women with cystic fibrosis and severe pulmonary function. Despite therapeutic progresses already made, pulmonary hypertension is associated to over 30% of mother-foetal morbidity and mortality. Approximately 1 in 1,000-1,500 pregnancies is affected by mother cancer. High rates of lung cancer morbility in women bring new and important challenges to therapy.
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