Predictors of maternal mortality among critically ill obstetric patients

Abstract

AimEvaluation of the predictors of maternal mortality among critically ill obstetric patients managed at the intensive care unit (ICU). MethodsA case control study to evaluate the predictors of maternal mortality among critically ill obstetric patients managed at the intensive care unit (ICU) of the University of Ilorin Teaching Hospital, Ilorin, Nigeria from 1st January 2010 to 30th June 2013. Participants were critically ill obstetric patients who were admitted and managed at the ICU during the study period. Subjects were those who died while controls were age and parity matched survivors. Statistical analysis was with SPSS-20 to determine chi square, Cox-regression and odds ratio; p value < 0.05 was significant. ResultsThe mean age of subjects and controls were 28.92 ± 5.09 versus 29.44 ± 5.74 (p = 0.736), the level of education was higher among controls (p = 0.048) while more subjects were of low social class (p = 0.321), did not have antenatal care (p = 0.131) and had partners with lower level of education (p = 0.156) compared to controls. The two leading indications for admission among subjects and controls were massive postpartum haemorrhage and severe preeclampsia or eclampsia. The mean duration of admission was higher among controls (3.32 ± 2.46 versus 3.00 ± 2.58; p = 0.656) while the mean cost of ICU care was higher among the subjects (p = 0.472). The statistical significant predictors of maternal deaths were the patient's level of education, Glasgow Coma Scale (GCS) score, oxygen saturation, multiple organ failure at ICU admission and the need for mechanical ventilation or inotrophic drugs after admission. ConclusionThe clinical state at ICU admission of the critically ill obstetric patients is the major outcome determinant. Therefore, early recognition of the need for ICU care, adequate pre-ICU admission supportive care and prompt transfer will improve the outcome.

Non‐obstetric causes of severe maternal complications: a secondary analysis of the Nigeria Near‐miss and Maternal Death Survey

“…In one report, most maternal deaths followed coagulation and respiratory dysfunction; however, most preventable maternal deaths were from obstetric complications . Fatality in critically ill obstetric patients has been reported to depend on the clinical state at admission to intensive care . Most women in low‐resource countries present late without referral note and are transported in poor conditions without provision for care in transit.…”

“…Fatality in critically ill obstetric patients has been reported to depend on the clinical state at admission to intensive care . Most women in low‐resource countries present late without referral note and are transported in poor conditions without provision for care in transit. Often, health facilities are poorly sited, 68% of women in this study live far from the facilities.…”

A case–control study of risk factors for maternal mortality in Burkina Faso in 2014

“…State of consciousness and the presence of a fever were associated with the occurrence of maternal death in the present study; whereas a 2014 Kenyan study by Yego et al [29] showed that the presence of fever was not associated with the occurrence of maternal death. Studies have shown that hemorrhage, septicemia, and eclampsia/pre‐eclampsia are the most common causes of death [6,23,29] and can influence the state of consciousness [30]. This raises the capacity of health facilities to support women in cases of obstetric complications.…”

Epidemiology, Outcomes and Risk Factors for Mortality in Critically–Ill Women Admitted to an Obstetric High Dependency Unit in a Resource–Limited Setting

“…Our study has several limitations. First, the retrospective design limited the availability of some clinically relevant variables such as parity, details on antenatal care, socio-economic information and foetal outcomes that were not collected in HDU charts (29). Secondly, although reason for admission in HDU…”