outline Introduction Objectives Methodology Results Discussion - - PowerPoint PPT Presentation

• utline
• Introduction
• Objectives
• Methodology
• Results
• Discussion
• conclusion

Introduction

• 830 women died every day ~ 2 women every 3minutes

due to complications of pregnancy and child birth.

• 99% of death from LMICs (WHO) report 2015
• PPH is the most common obstetric cause of ICU admission(1)
• PPH is associated with higher mortality rate in ICU (2)

(1) Sreenivas SK, Beevi NA, Devi UN. Clinical Characteristics and Outcome of Obstetric Patients Who Required Mechanical Ventilation in a Tertiary Care Hospital in North Kerala. Indian J Clin Pract. 2014

(2)Leung NYW, Lau a CW, Chan KKC, Yan WW. Clinical characteristics and outcomes of obstetric patients admitted to the Intensive Care Unit: a 10-year retrospective review. Hong Kong Med J. 2010;16

Study objectives

• primary objective :

To determine the outcome of PPH patients admitted in ICU CHUK In terms of: I. mortality and morbidity II. Hospital stay

• The secondary objective was to:
• To determine characteristics of PPH patients admitted in ICU

Methodology

• A retrospective, quantitative, descriptive study was performed.
• File record review of all subjects admitted in CHUK ICU 5years (2013-

2017)

• Variables analyzed include:
• 1. Social demographic information
• 2. Risks factors
• 3. Indication of ICU admission
• 4. Management received
• 5. ICU stay and mortality.

Results:Social demographic information

Basic information Numbers (percentage) Basic information Numbers (percentage) Total numbers of women with PPH 36(100%) Total numbers of women with PPH 36(100%) Time (year of admission) 2017 2016 2015 2014 2013 11(30.6%) 9(25%) 8(22.2%) 4(11.1%) 4(11.1%) Gestation age groups: Very preterm birth(<32 weeks) Moderate preterm birth(32 to 36 weeks) DNA Term birth(>36 to 42 weeks) 2(11.2%) 5(13.9%) 1(2.8%) 26(72.2%) Place of delivery Out (referred) In (CHUK) DNA 31(86.1%) 4(11.1%) 1(2.8%) Gravity: Low multipara Grand multipara DNA 15(41.7%) 17(47.3%) 4(11.1%) Age groups: <20 [20-30] [31-40] >40 1(2.8%) 18(50%) 13(36.1%) 4(11.1%) Economic status: Low Medium Higher DNA 17(47.2%) 16(44.4%) 1(2.8%) 2(5.6%)

36 participants, 86.1% cases from DH >50% under 30 yo Grand multipara and Low social economic status Increased risks of PPH

Results continued..

PPH was more in SVD & emergency s/c , prolonged labor invasive placenta. Uterine atony main cause of PPH. Shock and refractory hypotension were the main reason of admission

Results Continued

DIC was associated with High mortality rate. And mortality was higher in the first 24hours of admission

47.5% 77.7% 75% 86.1% 50% 8.3% 19.4% 13.9% 2.8% 13.9% 5.5%

5 10 15 20 25 30 35

Death Hystrectomy DIC MVM+ INOTROPE

Morbidity and mortality

yes no DNA

DISCUSSION

Our study Others studies Discussion and recommendation

• Mortality 47.5%
• higher mortality (52.2%)in

24hours

• Referred from DHs 86.1%
• higher than in India (30.7%)

and hongkong Strengthening ANC to identify high risk pregnancies.

• Training & Mentorship for

GPs and midwives at DHs

• Multidisplinary team
• The risk factor :The risk factor

:

• Emergency c/s, SVD
• Prolonged labor and invasive

placenta consistent with other recent

• studies. Except vaginal delivery
• Availability of uterotonics drugs
• Community education & ANC to

reduce Emerg S/C

• Implementation of guidelines

For EWSO

Shock requiring inotropes, and respiratory support were the common reasons of ICU admission

consistent with other recent studies

Aggressive fluid resuscitation

1.Sreenivas SK, Beevi NA, Devi UN. Clinical Characteristics and Outcome of Obstetric Patients Who Required Mechanical Ventilation in a Tertiary Care Hospital in North Kerala. Indian J Clin Pract. 2014

DISCUSSION

Our study Others studies Discussion and recommendation

• Complication

Hysterectomy (77.7%) DIC, Refractory HTN +inotropes

• DIC remain as potential

complication though the literature Prevention of DIC in the management of PPH is vital Limitations: Small sample size Study limited in ICU Missed data (DNA) consistent with other recent studies India (30 participants)

• unable to differentiate whether

More cases with indication of ICU in Maternity and HDU but Limited absence of bed (6 beds in ICU) Improving documentation of patient information

Hm K, Chava M, Jasmine N, Shetty N. Patients with postpartum hemorrhage admitted in intensive care unit : Patient condition , interventions , and outcome. 2011;27

Conclusion

• PPH is the leading cause of morbidity and mortality in ICU in this referral

hospital.

• DIC is a common complication with higher mortality.
• Mortality rate was higher in the first 24hours.
• DIC prevention in Mgt of PPH is vital.
• This indicate the need of strengthening the health facilities in the

management of third stage of labor and early identification of high risk pregnancies through ANC.

Questions and discussions

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