outline • 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 36(100%) Total numbers of women with PPH 36(100%) with PPH Time (year of admission) Gestation age groups: 36 participants, 2017 11(30.6%) Very preterm birth(<32 weeks) 2(11.2%) 86.1% cases from 2016 9(25%) Moderate preterm birth(32 to 36 weeks) 5(13.9%) DH 2015 8(22.2%) DNA 1(2.8%) 2014 4(11.1%) Term birth(>36 to 42 weeks) 26(72.2%) >50% under 30 yo 2013 4(11.1%) Grand multipara and Place of delivery Gravity: Out (referred) 31(86.1%) Low multipara 15(41.7%) Low social In (CHUK) 4(11.1%) Grand multipara 17(47.3%) economic status DNA 1(2.8%) DNA 4(11.1%) Increased risks of Age groups: Economic status: PPH <20 1(2.8%) Low 17(47.2%) [20-30] 18(50%) Medium 16(44.4%) [31-40] 13(36.1%) Higher 1(2.8%) >40 4(11.1%) DNA 2(5.6%)
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
Morbidity and mortality 86.1% 35 77.7% 75% 30 25 47.5% 50% 20 19.4% 15 5.5% 13.9% 10 13.9% 8.3% 2.8% 5 0 0 Death Hystrectomy DIC MVM+ yes no DNA INOTROPE
DISCUSSION Our study Others studies Discussion and recommendation Mortality 47.5% higher than in India (30.7%) Strengthening ANC to identify higher mortality (52.2%)in and hongkong high risk pregnancies. Training & Mentorship for 24hours Referred from DHs 86.1% GPs and midwives at DHs Multidisplinary team The risk factor :The risk factor Availability of uterotonics drugs consistent with other recent Community education & ANC to : studies. Except vaginal delivery reduce Emerg S/C Emergency c/s, SVD Implementation of guidelines Prolonged labor and invasive For EWSO placenta Shock requiring inotropes, and consistent with other recent Aggressive fluid resuscitation respiratory support were the studies common reasons of ICU admission 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 DIC remain as potential Complication Prevention of DIC in the Hysterectomy (77.7%) complication though the management of PPH is vital DIC, Refractory HTN literature +inotropes unable to differentiate whether Limitations: consistent with other recent More cases with indication of ICU in Small sample size studies India (30 participants) Maternity and HDU but Limited Study limited in ICU absence of bed (6 beds in ICU) Missed data (DNA) 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 Kubyara ni ugutanga ubuzima ntawagakwiye kubura ubuzima bwe mugihe atanga ubuzima
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