Schemes

Obstetric ICU

Background:

Gujarat has come a long way in improving Maternal Health. Maternal Mortality Ratio (MMR) has declined from 172 Maternal Death per 1,00,000 live births in 2001-03 to 112 Maternal Deaths per 1,00,000 live births in 2011-13, a 34% decline. (SRS Bulletins). Yet many women lose their life during pregnancy, child birth or during post-partum period due to complications of pregnancy.

Furthermore, many of these women do reach tertiary care institutions. There is a noticeable improvement in awareness in health care seeking as well as in referral transport system and road connectivity in the state in the recent past. As per Maternal Death Review Analysis for year 2014-15, 24% of maternal deaths were recorded in Medical College Hospitals. The causes of maternal deaths are different in Medical College Hospitals compared to overall causes of maternal mortality.

Apart from higher number and more complexity of cases admitted, Medical Colleges have unique challenge in form of ensuring continuous obstetric and intensive care to pregnant mothers. Due to competing priorities in existing ICUs, staff at these ICUs has difficulties to prioritize cases for admission to ICU. Once a woman with obstetric complication is shifted to general ICU the case management responsibility shifts to general ICU staff distancing care from the concerned obstetricians who knows about the detailed pre-existing and contributing obstetric history of the case.

Rationale:

To increase access to intensive care to life threatening obstetric complications by the co-ordinated efforts of obstetricians and intensive care specialists and to continue obstetric care during this period, it was proposed to establish dedicated Obstetric ICUs within Obstetrics departments in all Medical College Hospitals to ensure provision of appropriate obstetric and intensive care to pregnant mothers.

Objectives:

To establish Obstetric Intensive Care Units (Obs ICU) in Medical College Hospitals to ensure adequate obstetric and intensive care to pregnant mothers with life threatening complications, enhancing their survival opportunities.To develop standardize treatment protocols for improved outcomes in all Obs ICUs To develop Information Technology enabled monitoring system for real time monitoring of Obstetric ICU performance.

Structure of Obstetric ICU:

Proposal for establishing Obstetric ICU was prepared in co-ordination with Department of Obstetrics & Gynaecology from Medical College Hospitals. Initially it was proposed to start 6 bedded units in every hospital considering the average annual delivery load of these hospitals. Each Obstetric ICU has to have the following minimum Standards.

A. Human Resource:
  • 1 Intensivist/ Anaesthetist (Team leader)
  • 4 Medical Officers, for ensuring one Medical Officer round the clock in ICU
  • 12 Staff Nurses, for ensuring 3 staff nurse round the clock (patient: nurse ratio 2:1)
  • Monitoring & Evaluation assistant
  • Other key specialists on call basis – Internist; Paediatrician; Surgeon; Nephrologist
B. Equipments:

State level expert group on Obstetric ICU constituted with representation from every Medical College Hospital, where Obstetric ICU is proposed. This expert group discussed requirements and finalized list of major and minor equipments through consultative process. 15 major equipments were decided as necessary for every Obstetric ICU which includes ventilator, Portable USG & X-ray, Multi Para Monitor, Infusion pump etc.

C. Infrastructure:

All obstetric ICUs are proposed within existing Ob-Gy departments, within close proximity of existing labour rooms. All the facilities are asked to undertake need assessment for infrastructure development (Repair, Renovation or Expansion) in close co-ordination of PIU (Program Implementation Unit) of the district.

D. Funding:

First three Obstetric ICUs were established in 2014-15 at three Medical College Hospitals through NHM funds. Later on this initiative was up scaled using state and NHM budget to accelerate the pace of operationalizing Obstetric ICUs. Currently there are 20 Obstetric ICUs are planned for operationalization.

Phase wise operationalization plan of Obstetric ICUs in Gujarat

Phase Year Funding Name of Medical College Hospital
Phase1 2014-15 NHM
  • 1. New Civil Hospital, Surat
  • 2. G G Government Hospital, Jamnagar
  • 3. S S G Hospital, Vadodara
Phase 2 2015-16 State
  • 4. Civil Hospital, Ahmedabad
  • 5. PDU Medical College Hospital, Rajkot
  • 6. Sir T Hospital, Bhavnagar
NHM
  • 7. GMERS Medical College Hospital, Gandhinagar
  • 8. GMERS Medical College Hospital, Junagadh
  • 9. V S Hospital, Ahmedabad
Phase 3 2016-17 State
  • 10. GMERS Medical College Hospital, Valsad
  • 11. GMERS Medical College Hospital, Himmatnagar
  • 12. AMCMET Medical College Hospital, Ahmedabad
  • 13. SMIMER Medical College Hospital, Surat
NHM
  • 14. GMERS Medical College Hospital, Sula
Phase 4

2017-18

State
  • 15. GMERS Medical College Hospital, Gotri Vadodara
  • 16. GMERS Medical College Hospital, Dharpur Patan
  • 17. GMERS Medical College Hospital, Vadnagar
  • 18. GCS Medical College Hospital, Ahmedabad
  • 19. Shardaben Municipal General hospital, Ahmedabad
  • 20. Institute of Kidney Diseases and Research, Ahmedabad

Technical Support from UNICEF

UNICEF is state lead partner for RMNCH+A in Gujarat. Gujarat field office is involved in operationalizing Obstetric ICU since inception. The key contributions are as follows.

  • Support in developing concept note and scale up plans in consultation with experts from medical college hospitals.
  • Support in developing technical guidelines in consultation with expert group.
  • Developing standardized recording and reporting formats to monitor performance
  • Technical assistance for developing IT enabled monitoring system for Obs ICU.

6. Outcome:

Within short span of two years nearly 3200 mothers with complications have been admitted in these ICUs and most of them have been successfully discharged. As per the data of Surat Obstetric ICU, Maternal deaths in maternal near miss cases have significantly reduced from 2.3% before Obs ICU (14-15) to 1.1% after Obs ICU (15-16).

Gallery

Contact: (Please contact for any further detail on following address)

Dr. Prakash Vaghela, Additional Director (Family Welfare), H&FWD, Gujarat Block 5, Jivraj Mehta Bhavan, Old Sachivalaya, Gandhiangar, Gujarat. 382011
Phone: 079-23253211, E-mail: addir.health.fw@gmail.com

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