Introduction
Obstetric patients begin from pregnancy, childbirth to postpartum period in a new mother. During this period, patients require intensive care due to the risks they are likely to encounter during their delicate time in life. Critically obstetric patients require intensive care to ensure the safety of the mother and child throughout the four trimesters. The article role of critical care units in the management of obstetric patients was authored by Konstantinos Koukoubanis on 6th May 2021. The article poses questions like what challenges do obstetric patients undergo, the risks critical illnesses have on the mother and child, how to take care of the mother and child during illness and how to prevent the occurrence of illnesses during pregnancy of other children. This paper provides a critical analysis of the care of obstetric patients while in the critical care unit in attempts to protect the child and assure the survival of the mother and child when illnesses escalate.
Obstetric patients are vulnerable and critically ill obstetric patients require intensive care and surveillance throughout admission to the hospital due to risks of fatality. The article conducted a critical analysis of current electronically available databases on obstetric patients in intensive care. A thorough analysis of articles published up to late 2020 provided necessary data on patients admissions, a statistical representation of women affected by various critical disorders, and the best care provided for them to reduce the expected risks of fatality for the mother and child. Obstetric care begins during pregnancy, preparation for childbirth which is usually 48 hours before and after childbirth, and during their fourth trimester otherwise known as the postpartum period.
Article analysis and review
The articles aid the comprehension of the severity of complications encountered during pregnancy, childbirth, and the postpartum period. The authors provided a scope of the statistics necessary for a better understanding of the severity of the complications, the impacts they have on the mother and child while providing strategies for the care of the critically ill obstetric and postpartum patient. Pregnancy is a normal rite of passage for most women but some women encounter complications during pregnancy and childbirth that affect their conductivity during the postpartum stage. The need for care intensifies when the complications affect the fetus but treatment cannot be implemented without considering the impact medication or treatment strategy will have on its survival. Admission of obstetric patients greatly revolves around hypertensive complications of pregnancy and hemorrhage which are the most common disorders affecting pregnant women.
The severity of the disorders determines the approach administered to different patients and intensive care required to prevent loss of either the mother, the child, or both because every treatment provided in the intensive care unit aims at ensuring their survival and elimination of risks. Koukoubanis et al, 2021 reckoned that hospital admissions of critically ill pregnant women are about 14% while those in their postpartum period go up to 92% admissions requiring intensive care. The analysis of admissions provided clarity that maternal morbidity is high because the care provided is undermined by medical advancements. With changes in time and intensive implementation of advanced medical technology, maternal fatality was reduced by 50% due to early notation and anticipation of certain risks presented during tests and ultrasounds (Koukoubanis et al, 2021).
TheXXXlignsXXXnttation high-level intelligence increased the chances of identification of complications in either the mother or fetus. In so doing, treatment in early trimesters while preparing the parents on the complications visible on the child. Blanco and Cuza agreed with this information by providing the importance of ultrasounds. They retrieved ultrasounds of complications faced by pregnant mothers like signs of heart failure by a critical mitral valve stenosis patient (Blanco & Cuza, 2019). Through the test conducted, it is evident that intervention should be induced to prevent the loss of the patient during childbirth. Furthermore, the data enables the doctors to select the most effective and appropriate care for the patients and to prepare for expected risks during childbirth. Treatment can only be implemented with clarity of the condition of the patients and the likely risks that could be encountered if treatment begins. Dealing with pregnant women becomes risky because the fetus could be affected by the care subjected to the patient. In the occurrence of probable heart failure, doctors are capable of providing patients with suggestions on how to go about the disorder, the home-based care provided to her and her child before and after childbirth.
Hemorrhage affects women during childbirth whereby the hemoglobin concentration lowers especially during an operation. New mothers often have the fright of normal delivery and the consideration that they may not make it to persevere the pain that comes with it. Therefore they opt to have a delivery through C-section thus bringing about several complications like hemorrhage to the patient. Munoz et al, (2019) suggested that patient blood management is an important need for analysis whereby the blood concentration of patients is kept under the close scope to increase patient outcomes during delivery. Emphasis is further created on the obstetric emergency of hemorrhage that increases maternal mortality by 34% which is higher in low-resource countries than in developed countries (Munoz et al, 2019). The development of a nation increases the accessibility to quality maternal healthcare services which reduces the risks of mortality therefore maternal mortality is higher in African and Asian countries due to low technology implementation, scarcity of resources, and high poverty rates.
Limitation of resources and scarcity of high-level care maternal institutions in underdeveloped countries affects the care provided to obstetric patients. Koukoubanis et al, 2021 earlier suggested that the implementation of high-level technology improved the care provided to critically ill maternal patients, and progress is identified by the reduction in maternal mortality. Ismail and Sohaib (2019) agree with the information provided by stating that low- and middle-income countries are most affected by the care provided. These countries experience discrepancies in inaccessibility to quality healthcare facilities, the inadequacy of qualified health physicians, and resources like medication and infrastructure (Ismail & Sohaib, 2019). Poverty levels are high thus patients barely have enough to survive let alone attend high-level care hospitals that provide the required treatment plan for patients. Furthermore, the patients are unable to afford insurance covers that could cater to their hospital bills instead, they are forced to save for delivery with the little obtained from hand-to-mouth jobs. The scarcity of quality and equipped healthcare facilities affects childbirth whereby most mothers leave hospitals in pain due to infant mortality.
The article provides necessary statistical data to other researchers and professionals on the intensity of complications encountered during childbirth and how technology impacts care provided. Obstetric patients require care and surveillance of their conditions regardless of whether it is obstetric or non-obstetric. The research aims to identify the crisis and provide strategic measures to mitigate the effects it has on patients. The article aligns with the research conducted by other researchers on the types of critical illnesses and the necessary care needed to ensure the safety and survival of the mother and child. For instance, according to Vincent and Frise, about 20% of pregnancies are challenged by hemorrhage especially eclampsia which puts the fetus at high risk due to the symptom of seizures (Vincent & Frise, 2018). The occurrence of seizures leads to aggressive collapsing and for a pregnant mother, the risks of termination of pregnancy increase because they could easily hit against a hard surface. They could also be harmed during seizures, especially without the presence of a caregiver, the chances of survival for mother and child decline.
The strength of the articles lies in the capability of the authors to have information that aligns with that of other researchers. In so doing, it is evident that the data collected was researched and properly analyzed to come up with validated findings and conclusions. However, the weakness of the article is that the information provided was only collected from databases instead of increasing the weight of data through interviewing physicians on the risks they encounter when dealing with critically ill obstetric patients. Data could have been collected through observation of symptoms obtained through ultrasounds and scans thus providing detailed emphasis on the outcomes obtained
In conclusion, the care of critically ill obstetric patients is determined by the diagnosis and the effects that treatment plans would have on the safety of the mother and child. The most common complication exhibited is hemorrhage and hypertensive disorders that are exhibited during pregnancy and postpartum stages. Through the data provided, women are fragile and vulnerable during pregnancy therefore they require care and surveillance to increase the chances of healthy delivery and the postpartum period.
References
Blanco, P., & Abdo-Cuza, A. (2019). Point-of-care ultrasound in the critically ill pregnant or postpartum patient: what every intensivist should know. Intensive Care Medicine, 45(8), 1123-1126. https://doi.org/10.1007/s00134-019-05682-2
Ismail, S., & Sohaib, M. (2019). Critically ill obstetric patients in resource-limitedsettings. Journal Of Obstetric Anaesthesia And Critical Care, 9(2), 53. https://doi.org/10.4103/joacc.joacc_32_19
Koukoubanis, K., Prodromidou, A., Stamatakis, E., Valsamidis, D., & Thomakos, N. (2021). Role of Critical Care Units in the management of obstetric patients (Review). Biomedical Reports, 15(1). https://doi.org/10.3892/br.2021.1434
Muñoz, M., Peña-Rosas, J., Robinson, S., Milman, N., Holzgreve, W., & Breymann, C. et al. (2019). Patient blood management in obstetrics: prevention and treatment of postpartum hemorrhage. A NATA consensus statement. Transfusion Medicine, 17(2), 112-136. https://doi.org/10.2450/2019.0245-18
Vincent, L., & Frise, C. (2018). Management of the critically ill obstetric patient. Obstetrics, Gynaecology & Reproductive Medicine, 28(8), 243-252. https://doi.org/10.1016/j.ogrm.2018.07.005
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