Obstetrics critical care: a 2 years retrospective study in a medical college hospital of western India

Background: This study highlights the possibilities of new contribution to the management of high risk pregnancies and those pregnancies with unpredictable outcomes. The objective was to study the incidence and the clinical profile of antenatal and postpartum women requiring admission to the ICU, the interventions required in these women and final outcome.Methods: A retrospective cohort study of all obstetric critical care admissions during 2-year period from January 2016 to December 2017 was done at 1296 bedded tertiary care hospital. During the study total 349 obstetric patients were admitted to the ICU. The data were analysed by using percentage.Results: Primigravida (54.73%) were more as compared to multigravida (45.27%). Only 15.76% patients were in antepartum period while majority of patients (84.24%) were admitted during postpartum period. The main obstetric indications for ICU admission were pregnancy-induced hypertension (14.32%) followed by obstetric hemorrhage (9.16%) and community acquired pneumonia (7.44%). Other indications were valvular heart disease (5.44%), ANC with severe anemia (1.72%), monitoring (6.30%). In the present study maternal mortality among the women admitted to ICU was 18.05%. The leading cause of maternal death was obstetric hemorrhage (28.57%) followed by pregnancy induced hypertension (25.40%). An ICU intervention during the stay of the patients in terms of mechanical ventilation was used in 250 (71.63%) cases.Conclusions: A high quality multidisciplinary care is required in complicated pregnancies for safe motherhood. So, there is a need for dedicated ICU for obstetric patients

A comparative study of early and delayed cord clamping in term deliveries

Background: Timing of clamping of the umbilical cord has always been a debatable issue. Early cord clamping (ECC) is defined as clamping of the cord within 30 seconds of delivery of the baby and delayed cord clamping (DCC) is defined as clamping of the cord between 30 to 120 seconds of delivery. Delayed cord clamping, despite some limitations, is said to be beneficial to the neonate.  A comparative study between ECC and DCC was carried out on a select group of term pregnant women without any high-risk factor and delivering at term. Aim of the study was to compare the effects of early versus delayed cord clamping on neonates and mothers. The focus was on the neonatal haemoglobin levels and adverse effects, if any on neonates and mothers in the two groups.Methods: 100 women satisfying the inclusion/exclusion criteria were recruited for the study. They were randomly divided into two groups of 50 each. Group A underwent early cord clamping and Group B delayed cord clamping. Mothers were observed for 1 hour post-delivery for any evidence of post-partum haemorrhage. Neonates were observed for any sign of tachypnea and blood sample was sent after 72 hours of delivery for analyzing Hb, hematocrit and bilirubin of the neonate.Results: The results revealed that neonates with DCC had a higher mean Hb level of 15.02 vis-à-vis the ECC group Hb of 11.69G/dl and the difference was statistically significant. Similarly mean hematocrit of DCC group was 48.67 while the ECC group mean was 42.36, the difference again was statistically significant. There was no significant side effects or complications in both mother and newborn babies.Conclusions: It was concluded that delayed cord clamping should be practiced in otherwise non high-risk deliveries

A study of comparison of efficacy and side effects of intravenous paracetamol and intravenous diclofenac as a postoperative analgesic

BBackground: A postoperative patient suffers from pain the best relief of which is a clinician’s duty. Till date very few studies have been conducted for comparison of paracetamol and diclofenac as analgesics. As a result a comparative study between Paracetamol and Diclofenac was carried out. The aim of the study was to compare the efficacy and side effects of intravenous Paracetamol and intravenous Diclofenac in patients undergoing major abdominal open surgeries in obstetrics and gynaecology. The study was conducted to assess the postoperative visual analogue pain scores (VAS) and total analgesic requirement in the first 24 hours and also to study the total requirement of additional analgesics despite administration of either Paracetamol or Diclofenac in postoperative period.Methods: 100 patients satisfying the inclusion/exclusion criteria were recruited for the study. They were divided into two groups of 50 each. Group A was given IV Paracetamol 6 hourly for 48 hours starting 2 hours after surgery. Group B was given IV Diclofenac 8 hourly for 48 hours starting 2 hours after surgery. Patients were assessed for pain relief by visual analogue scale (VAS) of zero to ten after 6 hours, 12 hours, 24 hours and 48 hours of surgery by asking the patient to point the position on the 100 mm scale.Results: The results revealed that when we compared the VAS scores between the 2 Groups at different time intervals, it showed that at 24 hours and 48 hours VAS score in the Diclofenac Group was significantly less than the Paracetamol Group. The main side effects were nausea and vomiting in both the groups. There was more nausea and vomiting in Diclofenac group compared to Paracetamol group.Conclusions: It was concluded that at 24 hour and 48 hour pain reduction was more in the Diclofenac group as compared to Paracetamol group, but the side effects were more in the Diclofenac group compared to Paracetamol group