Epidemiology, Outcomes, and Risk Factors for Mortality in Critically Ill Women Admitted to an Obstetric High-Dependency Unit in Sierra Leone

Marotta, Claudia; Pisani, Luigi; Gennaro, Francesco Di; Cavallin, Francesco; Bah, Sarjoh; Pisani, Vincenzo; Beane, Abi; Trevisanuto, Daniele; Hanciles, Eva; Schultz, Marcus J.; Koroma, Michael M.; Putoto, Giovanni

doi:10.4269/ajtmh.20-0623

Cited by 8 publications

(10 citation statements)

References 26 publications

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“…Intensive intermediate Obstetric Critical Care is needed to address maternal complications and their sustainability low resource setting. Studies conducted in Sierra Leone showed an additional cost per QALY of only 10.0; the implementation and one-year running of the case studied obstetric a highly cost-effective innovation [17]. Cost-effective, proven Obstetric Critical Care is needed to address maternal complications.…”

Section: Plos Onementioning

confidence: 99%

Uterine prolapse and associated factors among reproductive-age women in south-west Ethiopia: A community-based cross-sectional study

et al. 2022

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Background Uterine prolapse is an important but neglected public health problem that causes maternal morbidity and mortality in women of reproductive age in low- and middle-income countries, including Ethiopia. However, little data are available concerning uterine prolapse in Ethiopia. The objective of this study was to assess the prevalence of and factors associated with uterine prolapse in women of reproductive age in Ethiopia. Methods A community-based cross-sectional study was conducted in Loma Woreda, Dawro, south-west Ethiopia, in November and December 2019. Four hundred and twenty-two randomly selected women of reproductive age participated in the study. Face-to-face interviews with a pre-structured questionnaire collected data, and diagnoses were made clinically. Epi Data v3.2.1 and SPSS v24 were used for data entry, processing, and analysis. Binary logistic regression was used to determine associations between dependent and independent variables. Variables with P-values less than 0.25 in bivariate logistic regression were further examined using multivariate logistic regression to investigate associations between the dependent variable and independent variables. Results The mean age of respondents was 35.4 ±7.994 years. The prevalence of symptomatic and anatomical uterine prolapse was 6.6% (28) and 5.9% (25), respectively. The prevalence of anatomical prolapse was used as a reference when determining associated factors. Age at first marriage (Adjusted Odd Ratio (AOR): 0.25, 95%CI 0.07, 0.89), place of delivery (AOR: 3.33, 95%CI 1.21, 9.13), birth attendant-assisted delivery (AOR 0.21; 95%CI 0.06, 0.71), and history of abortion (AOR: 2.94, 95%CI 1.08, 7.97) were found significantly and independently associated with the prevalence of uterine prolapse. Conclusion Uterine prolapse is common in women of reproductive age. Age at first marriage, place of delivery, birth attendant-assisted delivery, and history of abortion were independent predictors of the prevalence of uterine prolapse. We recommend that the health system link primary health care to hospital-set for uterine prolapse treatment programs. Health institution delivery should be encouraged by the local government. Early marriage and unwanted pregnancy need to be prevented through appropriate strategies.

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Section: Plos Onementioning

confidence: 99%

Uterine prolapse and associated factors among reproductive-age women in south-west Ethiopia: A community-based cross-sectional study

et al. 2022

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“…The major causes of maternal deaths in Africa are infections, postpartum hemorrhage, high blood pressure (preeclampsia and eclampsia), complications from delivery and unsafe abortion. [2][3][4][5] Substantial expenditure due to maternal complications could create a heavy economic burden to the households. Even when medical services are offered at reasonable prices or free of charge, indirect medical expenses associated with treatment may constitute a larger proportion of household income.…”

Section: Introductionmentioning

confidence: 99%

Cost of Treating Maternal Complications and Associated Factors in Mekelle General Hospital, Northern Ethiopia

Abadi

Mebratie

2021

RMHP

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“… 32 This does not imply a causal relationship with mortality, as parturients largely die of direct obstetric complications such as hemorrhage, eclampsia, and sepsis. 3 , 33 Yet, pulmonary complications led to frequent escalation of care. Although most obstetric critical illness can be treated in medium care units, 3 , 34 intensive care unit beds and mechanical ventilators are scarcely available in Africa.…”

Section: Discussionmentioning

confidence: 99%

Lung Ultrasound for Detection of Pulmonary Complications in Critically Ill Obstetric Patients in a Resource-Limited Setting

Pisani

Nicolo

Schiavone

et al. 2021

The American Journal of Tropical Medicine and Hygiene

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Critically ill parturients have an increased risk of developing pulmonary complications. Lung ultrasound (LUS) could be effective in addressing the cause of respiratory distress in resource-limited settings with high maternal mortality. We aimed to determine the frequency, timing of appearance, and type of pulmonary complications in critically ill parturients in an obstetric unit in Sierra Leone. In this prospective observational study, LUS examinations were performed on admission, after 24 and 48 hours, and in case of respiratory deterioration. Primary endpoint was the proportion of parturients with one or more pulmonary complications, stratified for the presence of respiratory distress. Secondary endpoints included timing and types of complications, and their association with “poor outcome,” defined as a composite of transfer for escalation of care or death. Of 166 patients enrolled, 35 patients (21% [95% CI: 15–28]) had one or more pulmonary complications, the majority diagnosed on admission. Acute respiratory distress syndrome (period prevalence 4%) and hydrostatic pulmonary edema (4%) were only observed in patients with respiratory distress. Pneumonia (2%), atelectasis (10%), and pleural effusion (7%) were present, irrespective of respiratory distress. When ultrasound excluded pulmonary complications, respiratory distress was related to anemia or metabolic acidosis. Pulmonary complications were associated with an increased risk of poor outcome (odds ratio: 5.0; 95% CI: 1.7–14.6; P = 0.003). In critically ill parturients in a resource-limited obstetric unit, LUS contributed to address the cause of respiratory distress by identifying or excluding pulmonary complications. These were associated with a poor outcome.

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Epidemiology, Outcomes, and Risk Factors for Mortality in Critically Ill Women Admitted to an Obstetric High-Dependency Unit in Sierra Leone

Cited by 8 publications

References 26 publications

Uterine prolapse and associated factors among reproductive-age women in south-west Ethiopia: A community-based cross-sectional study

Uterine prolapse and associated factors among reproductive-age women in south-west Ethiopia: A community-based cross-sectional study

Cost of Treating Maternal Complications and Associated Factors in Mekelle General Hospital, Northern Ethiopia

Lung Ultrasound for Detection of Pulmonary Complications in Critically Ill Obstetric Patients in a Resource-Limited Setting

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