title: Prospective evaluation of maternal morbidity and mortality in post-cesarean section patients admitted to postanesthesia intensive care unit.
abstract: OBJECTIVE
  Critical illness may complicate any pregnancy. Timely intensive care management of critically ill obstetric patients has better outcomes than expected from the initial severity of illness. The aim was to study the indications of transfer of post-cesarean section patients to post-anesthesia intensive care unit (PACU). (PACU transfer indicated that the patient required intensive care).
  
  
  METHODS
  This was a prospective observational study carried out in the PACU of a tertiary care teaching public hospital over a period of 2 years. Sixty-one postoperative lower segment cesarean section (LSCS) females admitted consecutively in PACU were studied. The study included obstetric PACU utilization rate, intensive care unit interventions, outcome of mother, Acute Physiology and Chronic Health Evaluation (APACHE II) score, and its correlation with mortality.
  
  
  RESULTS
  Postanesthesia intensive care unit admission rate was 2.8% and obstetric PACU utilization rate was 3.22%. Of 61 patients, four had expired. Obstetric indications (67.2%) were the most common cause of admission to PACU. Among the obstetric indications hemorrhage (36.1%) was found to be a statistically significant indication for PACU admission followed by hypertensive disorder of pregnancy (29.5%). Cardiovascular disease (16.4%) was the most common nonobstetric indication for PACU transfer and was associated with high mortality. The observed mortality was 6.557%, which was lower than predicted mortality by APACHE II Score.
  
  
  CONCLUSIONS
  Obstetric hemorrhage, hypertensive disorders of pregnancy and cardiovascular diseases are the leading causes of PACU admission in post LSCS patients. Prompt provision of intensive care to critically ill obstetric patients can lead to a significant drop in maternal morbidity and mortality.
authors.affiliation: Department of Anaesthesia, Topiwala National Medical College and B.Y L. Nair Ch. Hospital, Mumbai, Maharashtra, India.
authors.forename: Minal
authors.initials: M
authors.lastname: Harde
authors.affiliation: Department of Anaesthesia, Topiwala National Medical College and B.Y L. Nair Ch. Hospital, Mumbai, Maharashtra, India.
authors.forename: Sona
authors.initials: S
authors.lastname: Dave
authors.affiliation: Department of Anaesthesia, Topiwala National Medical College and B.Y L. Nair Ch. Hospital, Mumbai, Maharashtra, India.
authors.forename: Sachin
authors.initials: S
authors.lastname: Wagh
authors.affiliation: Department of Anaesthesia, Topiwala National Medical College and B.Y L. Nair Ch. Hospital, Mumbai, Maharashtra, India.
authors.forename: Pinakin
authors.initials: P
authors.lastname: Gujjar
authors.affiliation: Department of Medicine, Topiwala National Medical College and B.Y L. Nair Ch. Hospital, Mumbai, Maharashtra, India.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Bhadade
authors.affiliation: Department of Anaesthesia, Topiwala National Medical College and B.Y L. Nair Ch. Hospital, Mumbai, Maharashtra, India.
authors.forename: Aarati
authors.initials: A
authors.lastname: Bapat
keywords: Acute Physiology and Chronic Health Evaluation II; caesarean section; postanesthesia intensive care unit