Critically ill obstetric patients requiring mechanical ventilation in rural western India: A retrospective analysis.
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Date
2016-03
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Abstract
Background. There is a dearth of studies on the clinical
profile and therapeutic aspects of critically ill obstetric patients
from rural areas, especially those requiring tertiary care
support and ventilator therapy.
Methods. We retrospectively analysed the aetiological,
clinical, interventional and outcome-related factors of obstetric
patients requiring mechanical ventilation in western India. We
analysed factors that influence seeking of antenatal care,
pregnancy and its complications, severity assessment score,
indications and initiation of mechanical ventilation, multiorgan
failure and their correlation with maternal mortality.
Results. Of the 6708 obstetric admissions studied, 1112
were of critically ill (16.5%) patients and 200 (17%) of these
required mechanical ventilation. Over three-fourths (77%) of
patients were from rural areas, 83.5% were referred and 97%
had inadequate antenatal care. Severe pregnancy-induced
hypertension/eclampsia, massive haemorrhage and sepsis were
the common obstetric complications. Pulmonary oedema
(32.5%), acute respiratory distress syndrome (ARDS, 14%)
and acute lung injury (22.5%) were the three most common
indications for mechanical ventilation. In 26% of patients,
mechanical ventilation was initiated early based on a worsening
cardiorespiratory profile. A sequential organ failure assessment
score of >5 on admission and delay in treatment resulted in
multi-organ failure and worsening outcome. The maternal
mortality ratio was 32.5%, incidence of multi-organ dysfunction
syndrome was 71%, and pregnancy loss was 43.5%. The
odds ratio for maternal mortality in patients ventilated early
was 0.39 as against 5 in those with ARDS.
Conclusions. Inadequate antenatal care, delayed referral
practices, pregnancy-induced hypertension, obstetric
haemorrhage and sepsis remain the major causes of
complications in obstetric patients from rural areas. The
common indications for mechanical ventilation were pulmonary
oedema, ARDS and acute lung injury. Early initiation of
mechanical ventilation upon detection of imminent
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Vaishnav Smruti B , Vaishnav Bhalendu, Desai Kailas N, Raithatha Nitin S, Bose Neeta S. Critically ill obstetric patients requiring mechanical ventilation in rural western India: A retrospective analysis. National Medical Journal of India. 2016 Mar-Apr; 29(2):68-72.