Quantification of disorders in obstetrics needing intensive care in a low resource setting

BackgroundMany disorders can occur during pregnancy, birth and post birth.Some women become normal others become severely ill and some even die.It is essential to know the disorders, burden of diseases which lead to severe illness and profile of women, who become severely ill.Latest definition for such severely ill cases, 'maternal near miss' is 'a woman who survives severe life threatening conditions, either after receiving emergency medical/surgical interventions or otherwise, during pregnancy, abortion, childbirth or within 42 days of pregnancy termination', 1 based on existing definitions and a pilot study.[2][3][4][5] Severe illnesses naturally occur more frequently than deaths, and so provide more robust information than maternal deaths.They provide information about the quality of care available at various levels, but place a significant burden on health resources.[6][7][8][9] The reported incidence of MNM varies in different studies, and ranges from less than 1 per 1000 live births to 82 per 1000 live births.2,9-13 Danel et al. 14 reported some morbidity in 43% during hospitalization for delivery and 31% (1.2 million women) had at least one obstetric complication or at least 1 pre-existing medical condition.Despite substantial progress during the Millennium Development Goals, figures remain staggering 303000 women died due to pregnancy or childbirth-related causes.15 ObjectivesObjectives of present study were to know the burden and causes of severe illnesses during pregnancy, birth& post birth and profile of women who suffered severe illness. Material methodsAnalysis of critically ill obstetric cases managed over a period of 5 years in Obstetrics Gynaecology of Mahatma Gandhi Institute of Medical Sciences, a rural institute in central India was undertaken after approval of institute's ethics committee and consent of patient or accompanying relative.The inclusion criteria was, admission to intensive care area (ICA), which had facilities of 24-hours medical supervision, continuous vasoactive drug support& mechanical ventilation.5The limitation of the present study was case identification not as per the recently developed definition of MNM,1 which evolved through a project in which author was also part of the team.But this study is also the base of working on the project, after which the MNM definition evolved.During the study period, there were 32,655 obstetric admissions, 21,277 women delivered.Overall 455 women received intensive care, (study subjects).They accounted for 1.3% of obstetric admissions and 2.1% of births.