Pregnant and Postpartum Admissions to the Intensive Care Unit: A Ten-Year Review from Southwest Nigeria

Abstract

Background: Obstetric admissions into the Intensive Care Unit (ICU) reflect the scope of severe maternal morbidities and maternal near-miss events prevalent in the local obstetric population. Previous studies found no difference in the profile of ICU admissions between developing and developed countries. Therefore, differ- ences in ICU management outcomes may be associated more with the contextual nature of obstetric delays. Understanding the characteristics of patients needing ICU care may facilitate the early identification of obstetric risk, prompt risk assess- ment and timely transfer to the ICU. We studied the profiles and outcomes of such patients over 10 years. Objectives: To analyze the characteristics, profiles, and clinical outcomes of obstetric admissions into the ICU at a tertiary hospital setting. Methods: A retrospective review of 49 obstetric admissions into the University of Medical Sciences ICU in Ondo, southwest Nigeria was conducted. Relevant data was extracted into pro forma forms designed for this purpose. The ICU admission outcome was compared with the characteristics of these patients using binomial regression statistics. Results: The leading diagnoses associated with obstetric ICU admissions over the study period were hypertensive diseases of pregnancy (34.7%), sepsis (20.4%), anaesthetic/cardio-pulmonary complications (18.2%) and postpartum haemorrhage (12.2%). Over 70% of admissions had Glasgow coma scale scores of 8 or less. Clinical outcome was significantly associated with a Glasgow Coma Scale score of ≤ 8 on admission. Maternal mortality was 61%, the majority of which occurred within 24 hours of admission. Conclusions: The poor ICU admission outcome reflects the severity of the patient’s clinical status at presentation. The delay in seeking expert care might have worsened the already high severe maternal morbidity incidence in the community, contributing to the high mortality observed in this study. Efforts to mitigate late presentation at the tertiary centres require strong healthcare reforms. Efforts to establish high-depend- ency units should be explored to reduce the burden of obstetric admissions in the ICU.