INTRODUCTION
Maternal mortality is a grave injury to a family, community and the
entire nation. It remains unacceptably high with about 830 women dying
from pregnancy or childbirth related complications around the world
every day (WHO). Majority (99%) of all maternal deaths occur in
developing countries. Between 1990 and 2015, maternal mortality
worldwide dropped by about 44%from 385 to 216 maternal deaths per
100,000 live births. Despite this progress, the world still fell far
short of the Millennium Development Goals target of a 75% reduction in
the global MMR by 2015. Between 2016 and 2030, as part of the
sustainable development goals, the target is to reduce the global
maternal mortality ratio to less than 70 per 100000 live
births.1
It is of utmost importance that women at risk must be identified and
managed appropriately. “Near miss maternal mortality” or “Severe
Acute Maternal Morbidity” (SAMM) is more common than maternal mortality
and is defined as “a woman who nearly died but survived a complication
that occurred during pregnancy, childbirth or within 42 days after
termination of pregnancy”.2 As SAMM cases share many
characteristics with cases of maternal mortality3,4,
therefore understanding and managing SAMM (organ dysfunction/failure)
will help to decrease and/or prevent maternal mortality.
To achieve optimal management of women with SAMM, principles of critical
care management need to be applied.5 Critically ill
obstetric patients represent an interesting group with unique
characteristics whose management is challenged by the presence of a
fetus, an altered maternal physiology and disease specific to
pregnancy.5,6
The characteristics of these patients admitted to ICU (Intensive care
unit) including the sociodemographic factors are a useful tool to guide
us in better management of these patients in future. Also, the admission
of the obstetric patient to intensive care unit and their outcome is an
indirect indicator of health care status of a country. There are three
main factors that affect the outcome of emergency presentation during
pregnancy. These factors were defined, chronologically, as the lengths
of the delays in: (i) the decision to seek care, (ii) reaching an
appropriate medical facility, and (iii) the receipt of adequate and
appropriate treatment. Socioeconomic and cultural factors, accessibility
of facilities and quality of care may independently affect the lengths
of these three delays.6
Recently the report on “Strategies toward ending preventable maternal
mortality (EPMM Strategies), a direction-setting report outlining global
targets and strategies for reducing maternal mortality in the
Sustainable Development Goal (SDG) period published by WHO in 2015 also
reiterates the need to address the social, political, and economic
determinants of maternal health and mortality.7
In this regard, the present study was designed to evaluate the factors
responsible for ICU admission of obstetric patients, to analyze their
clinical characteristics, the associated levels of delay & correlate
these with the fetomaternal outcome.