A Study of Clinical Profile and Fetomaternal Outcome of Obstetric Patients Admitted to Intensive Care Unit: A Prospective Hospital-based Study.

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.

Spontaneous Vulvar Hematoma in Labor: A Rare Presentation.

Vulvar hematoma during pregnancy is a rare event. Usually they develop due to trauma post-delivery. Rarely such hematomas appear spontaneously intrapartum without any underlying cause. A 25-year-old primigravida at 34 weeks with twin pregnancy was found to have developed spontaneously a vulvar hematoma intrapartum. Prompt recognition and timely drainage of the hematoma prevented any untoward complication and led to quick recovery.

Predictive Value of Single Serum Progesterone Level for Viability in Threatened Miscarriage.

BACKGROUND: Bleeding is commonly seen during early pregnancy, and predicting the outcome of pregnancy in such cases is a difficult task. The aim of our study was to evaluate the predictive value of single serum progesterone level for finding the viability in threatened miscarriage and to determine the cut-off value for a viable ongoing pregnancy. METHODS: This was a prospective study in which patients attending the OPD with early pregnancy and bleeding were recruited. Inclusion criteria were period of amenorrhoea less than 12 weeks, complaints of bleeding per vaginum with or without lower abdominal pain and positive urine pregnancy test or serum beta HCG. Multiple pregnancies, inevitable miscarriage, ectopic pregnancy, molar pregnancy and pregnancy achieved by artificial reproductive techniques were excluded from this study. A detailed clinical examination was done, and routine investigations along with serum progesterone were done. Patients were followed up by serial ultrasound for viability, and their outcome was recorded. RESULT: A total of 150 patients with early pregnancy threatened miscarriage were enrolled for this study. Of the patients studied, 105 (70%) had a viable pregnancy and 45 (30%) had non-viable pregnancies. The mean serum progesterone was higher in the viable pregnancy, 17.97 ± 7.75 ng/ml, compared to non-viable group, 6.21 ± 2.86 ng/ml. The area under curve was calculated, and a cut-off value of 10.08 ng/ml was obtained. 83.8% of viable pregnancies had serum progesterone more than or equal to 10.08 ng/ml which was statistically significant. CONCLUSION: A single value of progesterone is useful in predicting the viability of the ongoing threatened pregnancy. Serum progesterone with a cut-off value of 10.8 ng/ml was found to have a positive predictive value of 95.7% and negative predictive value of 70.7% with an accuracy of 86%.

Prognostic factors of maternal near miss events and maternal deaths in a tertiary healthcare facility in India.

OBJECTIVE: To study maternal near miss (MNM) and maternal mortality to identify rectifiable risk factors. METHODS: The present cross-sectional retrospective study included pregnant women who experienced acute life-threatening pregnancy-related adverse events at Deen Dayal Upadhyay hospital, New Delhi, India, between September 1, 2009, and August 31, 2011. Patient data were analyzed to investigate factors associated with MNM events and maternal deaths. RESULTS: There were 369 patients included, and 302 MNM events and 67 maternal deaths were recorded. The recorded causes of MNM events included hemorrhage, hypertensive disorders, severe anemia with cardiac failure, organ failure, and infection in 192 (63.6%), 62 (20.5%), 13 (4.3%), 8 (2.6%), and 8 (2.6%) patients, respectively. Higher rates of anemia (P=0.007) and infection (P=0.007) were recorded among patients in the maternal death group than the MNMN group. CONCLUSION: Hemorrhage and hypertension were major causes of MNM events and are likely major barriers to reducing maternal mortality in low-income countries. Anemia and infection were significant prognostic factors of maternal death in the present study. MNM could be used as surrogate for maternal death in the provision of standard obstetric care.

Clinical Profiles of Dengue Infection during an Outbreak in Northern India.

Introduction. Dengue fever is an arboviral disease, which is transmitted by mosquito vector and presents as varied clinical spectrum of dengue fever (DF), dengue hemorrhagic fever (DHF), dengue shock syndrome (DSS), and expanded dengue syndrome (EDS) with atypical presentations, thus posing a diagnostic dilemma. Unless we are aware of these presentations, diagnosis as well as early initiation of treatment becomes difficult. We studied the various clinical presentations of dengue infection during an outbreak of disease in 2015. Materials and Methods. A total of 115 confirmed cases of dengue infection from Department of Medicine of Deen Dayal Upadhyay Hospital, New Delhi, were enrolled in this observational study. Results. The common signs and symptoms of dengue infection were fever, headache, body ache, backache, retro-orbital pain, bleeding manifestations, and rash in 100%, 87%, 86%, 58%, 41%, 21%, and 21%, respectively. Nonspecific or warning signs and symptoms included vomiting, weakness, abdominal pain, breathlessness, vertigo, sweating, and syncope. Other possible signs and symptoms of coinfections, comorbidities, or complications included diarrhea, sore throat, and neurological manifestations. There were seven patients with coinfections and four with comorbidities. The final diagnosis of these patients was DF (73%), DHF (16.5%), DSS (1.7%), and EDS (4.3%). Among EDS patients, the atypical presentations included encephalopathy, lateral rectus nerve palsy, acalculous cholecystitis, and myocarditis. Four patients required ICU care and there was no death in this study. Conclusion. Knowledge of atypical presentations is a must for early diagnosis and timely intervention to prevent life-threatening complications.