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Background: In resource-limited facilities, the greatest number of unfavorable maternal-fetal outcomes at referral hospitals is chronicled from emergency obstetric referrals of critically ill patients from lower health facilities. An efficient obstetric referral system is thus necessitated for improving maternal health. Referral practices have not been optimized effectively till date, owing to paucity of a detailed profile of referred women and indigenous barriers encountered during implementation process. Materials and methods: This five-year retrospective audit was conducted in the Department of Obstetrics and Gynecology, VMMC and Safdarjung Hospital, New Delhi from September 2018 to 2023, in which records of all critically ill obstetric women referred were reviewed. The primary outcomes included were proportion and pattern of patients being referred, while secondary outcomes included demographic variables, referring hospital, reason and number of steps in referral, duration of hospital stay and fetomaternal outcome. The data were recorded on a predesigned case proforma and analyzed using the SPSSv23 version of software, after application of appropriate statistical tests. Results: The referral rate to obstetric intensive care unit (ICU) ranged from 39 to 47% in last 5 years; hypertensive disorder of pregnancy (31%) being the foremost cause of the referrals. Around 2/3rd women were transferred without escort (70%) or prior communication (90.6%) and referral slips were incomplete in half the admissions. Conclusion: Ensuring emergency obstetric care (EmOC) at various levels by up-gradation of health infrastructure would go a long way in improving fetomaternal health outcomes. There is need of standardized referral slips tailor-made to each state and contextualized protocols for early recognition of complications and effective communication between referral centers. How to cite this article: Marwah S, Suri J, Shikha T, Sharma P, Bharti R, Mann M, et al. Referral Audit of Critically Ill Obstetric Patients: A Five-year Review from a Tertiary Care Health Facility in India. Indian J Crit Care Med 2024;28(8):734-740.
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A novel pump-probe Photothermal methodology using Quartz Tuning Fork (QTF) detector has been demonstrated for the first time. A tunable mid-IR Quantum Cascade Laser (QCL) and a CW fixed wavelength visible laser have been used as the pump and probe beam respectively. The developed Photothermal (PT) technique is based on Quartz Tuning Fork (QTF) detector for the detection of hazardous/explosive molecules adsorbed on plastic surface and also in aerosols form. PT spectra of various trace molecules in the fingerprinting mid- infrared spectral band 7-9 µm from distance of 25 m have been recorded. The PT spectra of explosives RDX, TNT and Acetone have been recorded at very low quantities. Acetone is the precursor of explosive Tri-Acetone Tri-Phosphate (TATP). The experimentations using pump and probe lasers, exhibit detection sensitivity of less than 5 µg/cm2 for RDX, TNT powders and of ~ 200 nl quantity for Nitrobenzene (NB) and Acetone (in liquid form) adsorbed on surfaces, from a distance of ~ 25 m. The sensitivity of the same order achieved from a distance of 15 m by using only a mid-IR tunable pump laser coupled to QTF detector. Thus the pump-probe PT technique is more sensitive in comparison to single tunable QCL pump beam technique and it is better suited for standoff detection of hazardous chemicals for homeland security as well as for forensic applications.
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Quantum cascade laser (QCL) based photoacoustic spectroscopic technique has been developed for detection of hazardous molecules contaminants/adsorbed on surfaces such as plastic and cloth from short standoff distances. The laser source and detection system is integrated together in a single unit. Spectra were recorded for traces of various molecules in mid-infrared spectral band (1130-1430â¯cm-1) from distance of 0.5â¯m. Pulsed quantum cascade laser source, modulated at 25â¯kHz and 42â¯kHz frequency was used to detect molecular species adsorbed on surfaces of cloth and plastic. Ultrasonic microphones operating at 25 and 42â¯kHz resonant frequencies were used as detectors. The photoacoustic spectra of hazardous chemicals, explosive materials and bio-chemicals such as acetic acid, PETN (pentaerythritol tetranitrate), DPA (dipicolinic acid) in very low quantities were recorded. Sensitivities of 5 and 10⯵g/cm2 of these analytes were achieved with frequencies of 25 and 42â¯kHz respectively at distance of 0.5â¯m. In the present technique there was no interference of audio frequency (20â¯Hz to 20â¯kHz) and bright sunlight. The technique can be applied for screening of suspicious objects for homeland security and forensic applications. The present spectroscopic technique can be developed in man portable standalone product.