Severe maternal morbidity in a general intensive care unit in Nigeria: clinical profiles and outcomes

Data on outcomes of obstetric admissions to intensive care units can serve as useful markers for assessing the quality of maternal care. We evaluated the intensive care unit utilization rate, diagnoses, case-fatality rate, mortality rate and associated factors among obstetric patients.

A prospective observational study of obstetric patients admitted to the general intensive care unit was performed. Women at 24 or more weeks of gestation, or within six weeks postpartum, who were admitted to the intensive care unit constituted the study population.

A total of 101 obstetric patients were admitted to the intensive care unit. Obstetric patients accounted for approximately 12% of all intensive care unit admissions. Over 90% of admissions were from direct obstetric morbidity such as hypertensive disorders (41.6%), major obstetric haemorrhage (37.6%) and sepsis (11.9%). Forty-three women (42.6%) died, giving an overall mortality rate of 1 in 2.4. Sepsis had the highest case-fatality rate (1 in 1.7) followed by obstetric haemorrhage (1 in 2.1) and hypertensive disorders (1 in 3.6). In univariable logistic regression analysis, abdominal delivery and/or peripartum hysterectomy, had 2.7-fold (95% CI 1.1 to 6.5) increased risk of maternal death as compared to vaginal delivery.

Direct obstetric morbidities constituted the leading reasons for obstetric admissions to the intensive care unit, with sepsis accounting for the highest case-fatality rate. Abdominal delivery and/or peripartum hysterectomy increased risk of death among obstetric admissions.