Baseline Patient Characteristics
Over the 5-year period 154 case notes of patients admitted to ICU during pregnancy and postpartum were reviewed. This contributes for 13% of all ICU admissions in the study period. The average age of the patients was 27.8 ±5.563 years. Out of the study population 4(2.6%) were Nulliparous, 75(48.7%) were primiparous and 75 (48.7%) were multiparous. Post-partum admissions (n=145, 94.2%) were significantly more as compared to ante-partum admissions (n=9, 5.8%).
The highest number of admissions came from the age group of less than or equal to 29 years, 101(65.6%). The patients were predominantly from Oromia, totaling 86 (55.8%). (Table 1)
Reasons for Admission
The various conditions necessitating ICU admissions are shown in Table 2 and 3. Obstetric reasons contribute for most of the ICU admissions, 122(79.2%). The most common obstetric conditions which necessitated ICU admission included Hypertensive Disorders of Pregnancy (n=75, 47.8%) and Obstetric Hemorrhage (n=20, 12.9%). Others include Infections, Acute fatty Liver of Pregnancy, Respiratory Failure, GTD, one case of IUFD with DIC and one case of Hyperemesis gravidarum complicated with electrolyte abnormalities (Table 2).
The most common non-obstetric admissions are cardiac disorder, 11(7.1%). Others are Respiratory failure, infections, Anesthesia Complications, Renal disorders, Neurologic disorders and one case of Road Traffic Accident with Acute Subdural Hematoma (Table 2).
The highest number of patients were admitted in the year 2017 (50 patients), whereas the lowest number of patients in the year 2020 (20 patients) (see Figure 1). The pattern of admission of the commonest causes of admission and death at ICU in mothers admitted to Intensive care unit during Pregnancy and Postpartum is shown in Fig 2.
Treatment given at ICU and Complications encountered
The mean length of stay at the ICU was 7 days (range 1–40) days, A total of 105 (68.2%) women needed mechanical ventilation. In the majority of patients’ antibiotics were given, 149(96.6%). Almost half of patients received antihypertensive therapy. Inotropic support was given to 63(40.9%) and blood (and its products) was given to 70(45.5%) of patients.
Twelve patients underwent at least one session of dialysis. Acute Kidney Injury resulting from Hypertensive disorders of pregnancy is the commonest indication for dialysis (9 cases). Other indications include Obstetric hemorrhage (1 case), Infection (1 case) and Other Renal Disorder (1 case). CPR was done for 51 patients and among these only 7 (13.7%) survived. (Table 4)
A total of 99 patients developed complications at ICU. Among these 51 patients developed only one complication, whereas 48 patients developed two or more complications. Hospital acquired pneumonia is the commonest complication encountered at ICU, 72(46.8%). Other complications include DIC, 47(30.5%), Multi organ failure, 39(25.3) and Genitourinary infection, 12(7.8%) (Table 4).
Outcomes of ICU admission
A total of 46 (29.9%) women died after ICU admission, whereas 108 (70.1%) survived. Among the survivors 92(59.7%) were near miss cases, 2(1.3%) patients were referred to other hospital and 1(0.6%) patient left against medical advice (LAMA) (Table 5).
The top five causes of admissions that accounted for 85% of total admissions were responsible for 84.7% of all deaths. Hypertensive disorders of Pregnancy, the commonest cause of admission, are the leading cause of death accounting for 45.6% of total deaths (Table 6).
Among the top five causes of admission, Infections had the highest case fatality proportion (71.4%) followed by obstetric hemorrhage (53.8%), whereas Anesthesia related complications has not resulted in any death.
Among 105 patients who required mechanical ventilation, 61(58%) survived, whereas 44(42%) died. When we compare these based on the length of stay on mechanical ventilation 47.9% (34/71) of patients who required mechanical ventilation for less than 7 days died while 29% (10/24) of patients who were on mechanical ventilation for more than 7 days died. Most (96%, 47/49) of those who didn’t need mechanical ventilation survived.
Not having follow up at this hospital [AOR, 5.480, CI(1.890-15.890), P-Value,0.002] and shorter ICU stay (less than 10 days) [AOR, 0.127, CI(0.028-0.572), P-value, 0.007] are strongly associated with death of mothers admitted to ICU. Those patients who require mechanical ventilation for less than 7 days are 22.9 times likely to die than those who don’t [AOR, 22.932, CI(4.983-105.540), P-Value <0.001]. Moreover, prolongation of stay on mechanical ventilation for more than 7 days increases the risk of death more [AOR, 37.533, CI(5.140-274.066), P-Value <0.001] (Table 7).