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Objectives: To investigate the indications, interventions and clinical outcomes of pregnant and newly delivered women admitted to the multidisciplinary intensive care unit. Study Design: Retrospective review / observational study. Setting and Duration: Critical care unit of Pakistan Navy Ship Shifa hospital Karachi from 1st August 2017 to 31st July 2018. Materials and Methods: This study was carried out in 13 bedded Intensive care units of PNS Shifa hospital Karachi, over a period of one year. All obstetrics admissions to ICU up to 42 days postpartum were included in the study, while those patients admitted after 42 days of delivery were excluded. Results: During the study period, 2688 women delivered and 66 obstetric patients were admitted to ICU, which was 7.5% of all ICU admission and it accounted for 2.4% of all deliveries. The most common indication for admission to ICU was hypertension disorders of pregnancy 45.4% followed by obstetric haemorrhage in 42.4% cases. 75% of the cases belonged to the age group of 21-35 years. The parity of 60% of patients was in the range of P2-P4. During the stay in ICU, 9% of patients were put on ventilator support, 40.9% had blood product transfusion, while 45% received antihypertensive and anticonvulsant therapy. Maternal mortality was 4.5%. Conclusion: Hypertensive disorder of pregnancy and obstetric hemorrhage were the main indications for admission to ICU. A multidisciplinary team approach and timely recognition of complications development can lead to a better maternal outcome. Universal availability of antenatal care can help in reducing serious complications and admissions to ICU. [ABSTRACT FROM AUTHOR]

Objective: To study the role of bilateral internal iliac artery ligation (BIAL) in arresting intractable postpartum haemorrhage. Methodology: This study of case series was conducted in Civil Hospital, Karachi, Pakistan from July 2008 to December 2009 over a period of one and half years during which all the patients who needed BIAL for control of severe obstetric haemorrhage were included and their detailed characteristics were recorded on a proforma. Main outcome measure was the effectiveness to control haemorrhage, which was assessed by the per-operative assessment of arrest of intraperitoneal or vaginal bleeding and need of additional hysterectomy. Result: During this period total eight patients underwent BIAL, three for PPH due to atony, two for placenta praevia and one each for placenta increta, ruptured uterus and coagulopathy. Three patients needed hysterectomy, out of which one followed BIAL because of failure to control bleeding (failure rate 16.66%). While two other patients underwent hysterectomy before BIAL. Failure to control bleeding was evident immediately and no patient needed re-laparotomy. Two women developed wound infection one maternal death occurred due to coagulopathy and its complications. None of the patient had iliac vein injury or any ischaemic complications during inpatient stay. Conclusions: We conclude that BIAL is a safe and effective procedure for treating life threatening obstetric haemorrhage with preservation of future reproductive capacity. [ABSTRACT FROM AUTHOR]