Manju Bala Dash
Mother Theresa Post Graduate and Research Institute of Health Sciences, India
Critical care helps people with life-threatening injuries and illnesses. It might treat problems such as complications from surgery, accidents, infections, and severe breathing problems. It involves close, constant attention by a team of specially-trained health care providers. Critical care usually takes place in an intensive care unit (ICU) or trauma center. Monitors, intravenous (IV) tubes, feeding tubes, catheters, breathing machines, and other equipment are common in critical care units. They can keep a person alive, but can also increase the risk of infection. Critical care is usually only offered to those whose condition is potentially reversible and who have a good chance of surviving with intensive care support. A prime requisite for admission to an intensive care unit (ICU) is that the underlying condition can be overcome. A wide gap exists in delivery of obstetrical critical care between developed and developing nations. This gap of quality care delivery between the two worlds is due to several factors, including clinical and economical. It may be attributable to the lower literacy rates, paucity of research in obstetrical critical care, poverty, lack of awareness, and the socio-cultural and behavioral factors prevalent in developing nations. The critically ill obstetric patient presents a unique clinical challenge to the intensivist because of maternal physiological adaptations to pregnancy, pregnancy specific conditions which may require critical care management and also the presence of a fetus whose well-being is linked to the mother. Successful maternal and neonatal outcomes for patients admitted to a critical care facility are largely dependent on a multidisciplinary approach to management requiring input from critical care personnel, obstetricians, anesthetists, neonatologists and midwives. The obstetric patient may be afflicted with any surgical/medical condition necessitating intensive care unit admission. There is however a number of pregnancy-specific conditions which account for the majority of critical care admissions. The commonest indication for critical care admission of obstetric patients is hemorrhage, both ante-partum and post-partum, amniotic fluid embolism, acute fatty liver, peri-partum cardiomyopathy, aspiration syndromes, infections etc. Hypertensive disorders, pre-eclampsia, and its related complications are also major contributory factors for such admissions. These reflect the lack of proper antenatal care and timely management of obstetrical emergencies, especially in the developing countries. The obstetrician’s involvement is of prime importance when managing such cases in the critical care. Medical diseases that may be aggravated during pregnancy - congenital heart diseases, rheumatic and non-rheumatic valvular diseases, pulmonary hypertension, anemia, renal failure etc. Conditions that are not related to pregnancy – trauma, asthma, diabetes, autoimmune diseases etc.
Manju Bala Dash has completed her PhD from Sri Ramachandra University, Chennai, Tamil Nadu. She has 20 years of teaching and research experience in the field of nursing. She is the National Trainer in IYCF (Infant and Young Child Feeding) Counseling Specialist course. She has published two books, contributed two chapters in two books published by the Nurses and Midwives Council, Tamil Nadu. She has published more than 20 papers in reputed journals and has been serving as an Editorial Board Member of repute.