Sukhminder Jit Singh Bajwa|Sukhwinder Kaur Bajwa
Critical care in obstetrics: Essentiality, initiatives, and obstacles in Indian scenario
Gian Sagar Medical College and Hospital|Gian Sagar Medical College and Hospital
make world better place reproductive health world health organization set targets drastically lower maternal mortality year 2015 prioritized one primary eightmillennium development goals formulated 2000 measures principally brainwork representatives developed nations however 99 total global maternal mortality developing nations defies basic fundamentals approaches adopted world health bodies involvement representatives developing nations seems justifiable necessity curbing menacing statistics 0209 obstetric admissions intensive care unit icu developed nations data reporting auditing uniform developing nations like india1234 spite formulating new health policies designing better reproductive health programs india current status termed far satisfactory portrays dismal picture reproductive health report 2008 table 1 globally stressed identify current potential future challenges nations design complement effective policies improve reproductive health uniform application current universal guidelines entirely feasible nations moreover nonconsensus one particular scoring system critically ill obstetric patient makes task intensivist difficult567table 1 maternal mortality rate 2008 per reportshortage quality manpower leads disturbingly low doctor patient ratio economic constraints poverty poor gross domestic product ratio deterrents early treatment seeking behavior nation daily bread earning challenge one incur expenses critical care services illiteracy status women strong desire male baby chiefly reflects gender discriminatory attitude leads higher incidence septic abortions female feticide pregnancy related complications lack clinical awareness related various pregnancy ailments observed literate illiterate sections society though widely variable prevalence8 delay treatment lead catastrophic complications progress irreversible stage patients treated quacks common scenario nation timely transportation critically ill obstetric patient matter sick patient also tough task many villages remote areas properly connected cities9 rightly quoted authors whose study published issue admission pregnant women icu considered objective marker severe maternal morbidity10 study patients puerperal sepsis intrauterine death coexisting sepsis higher mortality compared women pregnancy induced hypertension obstetric hemorrhage study emphasized need focus curtail rising incidence sepsis maternal mortality study retrospective study literary socioeconomic status patients acknowledged well recognized low socioeconomic status meager education poor antenatal care contribute significantly higher incidence obstetric complications2 local customs traditions sociobehavioral attitudes vary among different demographic groups nation factors times proved decisive obstacles nonadoption implementation evidencebased approaches management diseases pregnancy poor antenatal visit pattern adds management complicated pregnancies women comorbid diseases per national health family survey 2006 7 females came thirdtrimester antenatal checkups inadequate medical facilities drugs equipment besides shortage skilled manpower particularly rural areas compound problem managing critically ill obstetric patients imbalance disparity health infrastructure reflected location critical care units tertiary centers urban areas 6570 population resides rural areas discrepancy largely overcome allowing permission open new medical colleges rural areas particular focal point cater large population adjoining villages moreover civil hospitals community health centers attached medical institutions exchange medical education continuing medical educations conferences among medical fraternity vastly boost health services gross incoordination among different health providers public private notably due unavailability clear cut guidelines protocols related obstetrical critical care country subjective therapeutic interventions prove detrimental obstetric patients underreporting nonreporting critical obstetrical data another contributory factor prevailing poor reproductive health services2 caring critically ill obstetric patient ideally requires dedicated obstetric care unit managed coordinated efforts multidisciplinary team consisting obstetrician anesthesiologist intensivist pediatrician design various structural functional aspects obstetric icu11 similar attempts made harde et al prospective observational study besides assessing factors necessitating admission 61 parturients pacu cesarean section also evaluated maternal morbidity mortality basis intensive care unit interventions based acute physiology chronic health evaluation apache ii score observed mortality rate 65 among parturients mainly admitted pacu obstetric indications 672 hemorrhage 361 hypertensive disorder pregnancy 295 others cardiovascular disease 164 common nonobstetric indication associated higher mortality12 outcome study stresses upon timely intervention obstetrical complications significantly reduce maternal morbidity mortality12 india land diversities health administration health needs also follow similar pattern different states make health issues primarily state matter kerala tamil nadu states taken lead achieving reduction maternal mortality rates shown positive trends majority health indicators largely attributed stewardship role successive governments years bearing fruitful results surprisingly number critical care obstetrical icus states similar indian states maternal health portrays positive statistical figures table 2 government health administrators tried time time impact implementation various reproductive health policies termed mild achieved partial success failure attributed various administrative social attitudinal economic political factors cannot dwelled upon short editorialtable 2 comparison maternal mortality rates different states indiaall mentioned challenges possibly managed concrete measures involving multidisciplinary approach coordinated dedicated efforts government officials physicians paramedical staff importantly active participation society general public recruitment new specialists implementation rotational policy compulsory posting rural areas giving higher pay scales incentives specialists paramedical staff working rural areas providing accommodation recreational facilities monthly posting postgraduate trainees supervision tide shortage manpower demand large extent newer health policies formulated funds reallocated aims gradation existing icus highdependency units institutions setting obstetric icus besides critical care units incorporated newer clause mandatory requirement newer medical colleges times economic recession progressive devaluation currency become mandatory reallocate health budget toward primary critical care health services diagnostic needs prophylactic measures therapeutic interventions planned preferably antenatal visits general helpline contact number attending physician given patients literacy drive encouraged manner customs traditions superstitions seen scientific angle13 well equipped ambulances deployed focal points attend critically ill obstetric patient timely manner improving logistical operations providing facilities deliveries neonatal resuscitation maternal monitoring transportation positive outcome reproductive health2 commonly followed guidelines american college critical care medicine modified per circumstances health setups national needs icu admission criterion varies significantly one place another research data reporting strengthening health infrastructure grassroot level simple early initiatives close monitoring symptomatic care general measures drastically help reducing maternal morbidity mortality global level planning formulation guidelines involve representative developed developing nations consensus guidelines arrived considering prevailing health scenarios sociopolitical circumstances availability resources developing nations practical feasible application universal guidelines thus could enabled go long way aiding provision quality care highrisk obstetrical emergencies