title: Critically ill obstetric patients requiring mechanical ventilation in rural western India: A retrospective analysis.
abstract: BACKGROUND
  There is a dearth of studies on the clinical profile and therapeutic aspects of critically ill obstetric patients from rural areas, especially those requiring tertiary care support and ventilator therapy.
  
  
  METHODS
  We retrospectively analysed the aetiological, clinical, interventional and outcome-related factors of obstetric patients requiring mechanical ventilation in western India. We analysed factors that influence seeking of antenatal care, pregnancy and its complications, severity assessment score, indications and initiation of mechanical ventilation, multiorgan failure and their correlation with maternal mortality.
  
  
  RESULTS
  Of the 6708 obstetric admissions studied, 1112 were of critically ill (16.5%) patients and 200 (17%) of these required mechanical ventilation. Over three-fourths (77%) of patients were from rural areas, 83.5% were referred and 97% had inadequate antenatal care. Severe pregnancy-induced hypertension/eclampsia, massive haemorrhage and sepsis were the common obstetric complications. Pulmonary oedema (32.5%), acute respiratory distress syndrome (ARDS, 14%) and acute lung injury (22.5%) were the three most common indications for mechanical ventilation. In 26% of patients, mechanical ventilation was initiated early based on a worsening cardiorespiratory profile. A sequential organ failure assessment score of >5 on admission and delay in treatment resulted in multi-organ failure and worsening outcome. The maternal mortality ratio was 32.5%, incidence of multi-organ dysfunction syndrome was 71%, and pregnancy loss was 43.5%. The odds ratio for maternal mortality in patients ventilated early was 0.39 as against 5 in those with ARDS.
  
  
  CONCLUSIONS
  Inadequate antenatal care, delayed referral practices, pregnancy-induced hypertension, obstetric haemorrhage and sepsis remain the major causes of complications in obstetric patients from rural areas. The common indications for mechanical ventilation were pulmonary oedema, ARDS and acute lung injury. Early initiation of mechanical ventilation upon detection of imminent.
authors: Department of Obstetrics and Gynaecology, Pramukhswami Medical College, H.M. Patel Centre for Medical Care and Education, Karamsad 388325, Gujarat, India.
authors: Smruti B
authors: SB
authors: Vaishnav
authors: Department of Medicine, Pramukhswami Medical College, H.M. Patel Centre for Medical Care and Education, Karamsad 388325, Gujarat, India.
authors: Bhalendu
authors: B
authors: Vaishnav
authors: Department of Obstetrics and Gynaecology, Pramukhswami Medical College, H.M. Patel Centre for Medical Care and Education, Karamsad 388325, Gujarat, India.
authors: Kailas N
authors: KN
authors: Desai
authors: Department of Obstetrics and Gynaecology, Pramukhswami Medical College, H.M. Patel Centre for Medical Care and Education, Karamsad 388325, Gujarat, India.
authors: Nitin S
authors: NS
authors: Raithatha
authors: Department of Anaesthesia, Pramukhswami Medical College, H.M. Patel Centre for Medical Care and Education, Karamsad 388325, Gujarat, India.
authors: Neeta S
authors: NS
authors: Bose
mesh_terms: D000328:Adult; D016638:Critical Illness / Q000453:epidemiology*; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D004461:Eclampsia; D005260:Female; D006470:Hemorrhage; D006801:Humans; D007194:India / Q000453:epidemiology; D009102:Multiple Organ Failure; D010298:Parity; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011654:Pulmonary Edema; D012372:ROC Curve; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D055815:Young Adult