A ten-year review of indications and outcomes of obstetric admissions to an intensive care unit in a low-resource country

Abstract

Introduction Obstetric intensive care unit admission (ICU) suggests severe morbidity. However, there is no available data on the subject in Ghana. This retrospective review was conducted to determine the indications for obstetric ICU admission, their outcomes and factors influencing these outcomes to aid continuous quality improvement in obstetric care. Methods This was a retrospective review conducted in a tertiary hospital in Ghana. Data on participant characteristics including age and whether participant was intubated were collected from patient records for all obstetric ICU admissions from 1st January 2010 to 31st December 2019. Descriptive statistics were presented as frequencies, proportions and charts. Hazard ratios were generated for relations between obstetric ICU admission outcome and participant characteristics. A p-value <0.05 was deemed statistically significant. Results There were 443 obstetric ICU admissions over the review period making up 25.7% of all ICU admissions. The commonest indications for obstetric ICU admissions were hypertensive disorders of pregnancy (70.4%, n = 312/443), hemorrhage (14.4%, n = 64/443) and sepsis (9.3%, n = 41/443). The case fatality rates for hypertension, hemorrhage, and sepsis were 17.6%, 37.5%, and 63.4% respectively. The obstetric ICU mortality rate was 26% (115/443) over the review period. Age ≥25 years and a need for mechanical ventilation carried increased mortality risks following ICU admission while surgery in the index pregnancy was associated with a reduced risk of death. Conclusion Hypertension, haemorrhage and sepsis are the leading indications for obstetric ICU admissions. Thus, preeclampsia screening and prevention, as well as intensifying antenatal education on the danger signs of pregnancy can minimize obstetric complications. The establishment of an obstetric HDU in CCTH and the strengthening of communication between specialists and the healthcare providers in the lower facilities, are also essential for improved pregnancy outcomes. Further studies are needed to better appreciate the wider issues underlying obstetric ICU admission outcomes. Plain language summary This was a review of the reasons for admitting severely-ill pregnant women and women who had delivered within the past 42 days to the intensive care unit (ICU), the admission outcomes and risk factors associated with ICU mortality in a tertiary hospital in a low-resource country. High blood pressure and its complications, bleeding and severe infections were observed as the three most significant reasons for ICU admissions in decreasing order of significance. Pre-existing medical conditions and those arising as a result of, or aggravated by pregnancy; obstructed labour and post-operative monitoring were the other reasons for ICU admission over the study period. Overall, 26% of the admitted patients died at the ICU and maternal age of at least 25 years and the need for intubation were identified as risk factors for ICU deaths. Attention must be paid to high blood pressure during pregnancy.

Caring for two in the ICU: Pharmacologic management of pregnancy‐related complications

“…1 Primary reasons for pregnant patients requiring admission to an intensive care unit (ICU) include preeclampsia and eclampsia, hemorrhage, cardiovascular conditions, and sepsis. 2 In 2020, a World Health Organization global survey on maternal and newborn health indicated that ICU utilization was associated with a significant reduction in the odds of maternal death and severe maternal morbidity (SMM) among obstetric patients with severe conditions. 3 An obstetric emergency is defined as a condition that necessitates immediate action to prevent SMM or mortality.…”

“…However, the United States (US) continues to see a rise in maternal mortality ratio (number of maternal deaths per 100,000 live births) in contrast to what is observed in other industrialized countries 1 . Primary reasons for pregnant patients requiring admission to an intensive care unit (ICU) include preeclampsia and eclampsia, hemorrhage, cardiovascular conditions, and sepsis 2 . In 2020, a World Health Organization global survey on maternal and newborn health indicated that ICU utilization was associated with a significant reduction in the odds of maternal death and severe maternal morbidity (SMM) among obstetric patients with severe conditions 3 …”