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.