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Papers by gopal thota

Open Journal of Obstetrics and Gynecology, 2013

Objectives: To evaluate the various scoring systems, APACHE II, SOFA, SAPS II and MPM for the pre... more Objectives: To evaluate the various scoring systems, APACHE II, SOFA, SAPS II and MPM for the prediction of prognosis of the obstetric critically ill patients admitted in a well supported ICU unit. Material and methods: A prospective, observational study was conducted among all the obstetric patients admitted to the ICU between October 2011 and December 2012, during a period of 15 months. The data collected were of three categories: demographic, obstetric and ICU related. Results and Analysis: The patients admitted in the postpartum period (n = 28, 53.84%) were more than the antenatal admissions (n = 24, 46.16%). 32.69% of admissions were in the third trimester. The most common mode of delivery was emergency caesarean section (n = 27/40, 67.5%). Total caesarean deliveries were 35/40 = 87.5% in ICU patients. The mortality prediction scores were calculated for 41 patients only as acid blood gas analysis was not available for the rest. Patients required ventilation-51.92%, hemodialysis-19.23%, inotropic support-38.46%, blood transfusion-50%. Analysis of the statistical data for ICU parameters has shown that hospital stay (p = 0.011) and ventilation days (p = 0.014) are significant predictors of maternal outcome. Age (p = 0.789), ICU stay (p = 0.701) and RRT (p = 0.632) are not significant. Among the obstetric ICU admissions, hypertensive disorders of pregnancy (30.76%) was the predominant cause followed by obstetric haemorrhage (23.07%). Discussion: HELLP syndrome and eclampsia (n = 4, 57%) were the major causes of maternal deaths with anaesthetic mishaps accounting for 29% (n = 2). One (14%) death was due to Eisenmenger's syndrome. In one case of H1N1 admitted with ARDS, caesarean section was done in MICU for worsening respiratory distress. The maternal mortality in this series of cases was 7/52 = 13.46%, excluding the unavoidable cases of maternal death (3 cases brain dead at admission and one cardiac arrest in emergency room), our maternal mortality rate is 3/48 = 6.25%. The predicted mortality as measured by all scoring systems (for 41 patients) was between 17% and 30%. The observed mortality was around 17%. Hence a reduction in mortality of 40% has been achieved due to intensive care. Conclusions: Leading cause of maternal mortality was HELLP syndrome. Hypertensive disorders of pregnancy were the most common cause of admission to ICU. In this study, all the scores were equally significant in predicting maternal mortality. Amongst the interventions done for these patients mechanical ventilation seems to have an influence on the overall outcome.

O ur patient, a 90 yr. old gentleman, weighing 70 kilogram, with a CT diagnosis of Stage IV Carci... more O ur patient, a 90 yr. old gentleman, weighing 70 kilogram, with a CT diagnosis of Stage IV Carcinoma bladder was scheduled for a palliative endoscopic fulgaration or transurethral resection of bladder tumor ( TURBT ) . His complaints were dysuria and hematuria for which he already had a Foleys catheter in situ. He was a known hypertensive for past 20 years on Tab Atenolol 25 mg once daily, Tab Indapamide 2.5 mg once daily, Tab Atorvastatin 40 mg once daily (at bed time) and Tab Aspirin 75 mg once daily. His investigations were as follows: Hemoglobin-11 gm%, Packed cell volume -32 %, Platelet count-1.8 lacs/cumm, Blood urea-27 mg%, Serum creatinine-1 mg%, Serum sodium-140 meq/L, Serum potassium-4 meq/L, random blood sugar-118 mg%. His 12 lead electrocardiogram and 2D echocardiogram were within normal limits. The Urologist informed us that it was a stage IV carcinoma bladder which was as a sessile growth on the right lateral wall of urinary bladder. He was worried because while if the obturator nerve gets stimulated during surgery, thebladder can get perforated. Hence we planned spinal anesthesia along with ultrasound guided right obturator nerve block for surgery. We per-

Open Journal of Obstetrics and Gynecology, 2013

Objectives: To evaluate the various scoring systems, APACHE II, SOFA, SAPS II and MPM for the pre... more Objectives: To evaluate the various scoring systems, APACHE II, SOFA, SAPS II and MPM for the prediction of prognosis of the obstetric critically ill patients admitted in a well supported ICU unit. Material and methods: A prospective, observational study was conducted among all the obstetric patients admitted to the ICU between October 2011 and December 2012, during a period of 15 months. The data collected were of three categories: demographic, obstetric and ICU related. Results and Analysis: The patients admitted in the postpartum period (n = 28, 53.84%) were more than the antenatal admissions (n = 24, 46.16%). 32.69% of admissions were in the third trimester. The most common mode of delivery was emergency caesarean section (n = 27/40, 67.5%). Total caesarean deliveries were 35/40 = 87.5% in ICU patients. The mortality prediction scores were calculated for 41 patients only as acid blood gas analysis was not available for the rest. Patients required ventilation-51.92%, hemodialysis-19.23%, inotropic support-38.46%, blood transfusion-50%. Analysis of the statistical data for ICU parameters has shown that hospital stay (p = 0.011) and ventilation days (p = 0.014) are significant predictors of maternal outcome. Age (p = 0.789), ICU stay (p = 0.701) and RRT (p = 0.632) are not significant. Among the obstetric ICU admissions, hypertensive disorders of pregnancy (30.76%) was the predominant cause followed by obstetric haemorrhage (23.07%). Discussion: HELLP syndrome and eclampsia (n = 4, 57%) were the major causes of maternal deaths with anaesthetic mishaps accounting for 29% (n = 2). One (14%) death was due to Eisenmenger's syndrome. In one case of H1N1 admitted with ARDS, caesarean section was done in MICU for worsening respiratory distress. The maternal mortality in this series of cases was 7/52 = 13.46%, excluding the unavoidable cases of maternal death (3 cases brain dead at admission and one cardiac arrest in emergency room), our maternal mortality rate is 3/48 = 6.25%. The predicted mortality as measured by all scoring systems (for 41 patients) was between 17% and 30%. The observed mortality was around 17%. Hence a reduction in mortality of 40% has been achieved due to intensive care. Conclusions: Leading cause of maternal mortality was HELLP syndrome. Hypertensive disorders of pregnancy were the most common cause of admission to ICU. In this study, all the scores were equally significant in predicting maternal mortality. Amongst the interventions done for these patients mechanical ventilation seems to have an influence on the overall outcome.

O ur patient, a 90 yr. old gentleman, weighing 70 kilogram, with a CT diagnosis of Stage IV Carci... more O ur patient, a 90 yr. old gentleman, weighing 70 kilogram, with a CT diagnosis of Stage IV Carcinoma bladder was scheduled for a palliative endoscopic fulgaration or transurethral resection of bladder tumor ( TURBT ) . His complaints were dysuria and hematuria for which he already had a Foleys catheter in situ. He was a known hypertensive for past 20 years on Tab Atenolol 25 mg once daily, Tab Indapamide 2.5 mg once daily, Tab Atorvastatin 40 mg once daily (at bed time) and Tab Aspirin 75 mg once daily. His investigations were as follows: Hemoglobin-11 gm%, Packed cell volume -32 %, Platelet count-1.8 lacs/cumm, Blood urea-27 mg%, Serum creatinine-1 mg%, Serum sodium-140 meq/L, Serum potassium-4 meq/L, random blood sugar-118 mg%. His 12 lead electrocardiogram and 2D echocardiogram were within normal limits. The Urologist informed us that it was a stage IV carcinoma bladder which was as a sessile growth on the right lateral wall of urinary bladder. He was worried because while if the obturator nerve gets stimulated during surgery, thebladder can get perforated. Hence we planned spinal anesthesia along with ultrasound guided right obturator nerve block for surgery. We per-