PLoS One. 2021 Dec 31;16(12):e0261974. doi: 10.1371/journal.pone.0261974. eCollection 2021.
A ten-year review of indications and outcomes of obstetric admissions to an intensive care unit in a low-resource country.
PloS one
Betty Anane-Fenin, Evans Kofi Agbeno, Joseph Osarfo, Douglas Aninng Opoku Anning, Abigail Serwaa Boateng, Sebastian Ken-Amoah, Anthony Ofori Amanfo, Leonard Derkyi-Kwarteng, Mohammed Mouhajer, Sarah Ama Amoo, Joycelyn Ashong, Ernestina Jeffery
Affiliations
Affiliations
- Department of Obstetrics and Gynaecology, Cape Coast Teaching Hospital, Cape Coast, Ghana.
- Department of Obstetrics and Gynaecology, University of Cape Coast School of Medical Sciences, Cape Coast, Ghana.
- Department of Community Medicine, School of Medicine, University of Health and Allied Sciences, Ho, Ghana.
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
- Department of Pathology, University of Cape Coast School of Medical Sciences, Cape Coast, Ghana.
- Intensive Care Unit, Cape Coast Teaching Hospital, Cape Coast, Ghana.
PMID: 34972184
PMCID: PMC8719704 DOI: 10.1371/journal.pone.0261974
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.
Conflict of interest statement
The authors have declared that no competing interests exist.
References
- Afr J Reprod Health. 2021 Feb;25(1):56-66 - PubMed
- Fertil Steril. 2015 May;103(5):1136-43 - PubMed
- Aust N Z J Obstet Gynaecol. 2011 Jun;51(3):233-8 - PubMed
- J Crit Care. 2021 Feb;61:76-81 - PubMed
- Med Sci Monit. 2020 Feb 22;26:e919922 - PubMed
- J Obstet Gynaecol. 2006 Jul;26(5):418-23 - PubMed
- BJOG. 2020 Nov;127(12):1558-1567 - PubMed
- Int J Obstet Anesth. 2004 Jul;13(3):164-6 - PubMed
- Indian J Public Health. 2016 Apr-Jun;60(2):159-63 - PubMed
- Obstet Gynecol Sci. 2018 Mar;61(2):209-219 - PubMed
- BMC Womens Health. 2021 Jun 19;21(1):248 - PubMed
- Matern Child Health J. 2015 Jun;19(6):1202-11 - PubMed
- Med J Armed Forces India. 2013 Apr;69(2):134-7 - PubMed
- Anaesth Crit Care Pain Med. 2016 Oct;35 Suppl 1:S51-S57 - PubMed
- Intensive Care Med. 2010 Feb;36(2):256-63 - PubMed
- Int J Obstet Anesth. 2019 Aug;39:99-104 - PubMed
- J Crit Care. 2017 Feb;37:270-276 - PubMed
- Ghana Med J. 2012 Jun;46(2 Suppl):69-78 - PubMed
- Intensive Care Med. 2010 Sep;36(9):1465-74 - PubMed
- BMC Pregnancy Childbirth. 2017 Jun 19;17(1):194 - PubMed
- Semin Perinatol. 2009 Jun;33(3):130-7 - PubMed
- Malawi Med J. 2015 Mar;27(1):16-9 - PubMed
- Healthcare (Basel). 2021 Mar 03;9(3): - PubMed
- PLoS One. 2019 Feb 28;14(2):e0213240 - PubMed
- Ethn Dis. 2014 Summer;24(3):283-9 - PubMed
- Int Sch Res Notices. 2015 Jan 08;2015:208043 - PubMed
- Ghana Med J. 2007 Dec;41(4):154-9 - PubMed
- Int J Gynaecol Obstet. 2013 Nov;123(2):110-3 - PubMed
- BMC Pregnancy Childbirth. 2021 May 25;21(1):401 - PubMed
- J Hum Hypertens. 2010 Feb;24(2):104-10 - PubMed
- PLoS One. 2015 Jan 24;10(1):e0116949 - PubMed
Publication Types