M Prin1, C Kadyaudzu2, K Aagaard3, A Charles4. 1. Department of Anesthesiology, Baylor College of Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA. Electronic address: prin@bcm.edu. 2. Kamuzu Central Hospital, Lilongwe, Malawi. 3. Department of Obstetrics & Gynecology, Baylor College of Medicine, Houston, TX, USA. 4. Dept. of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Abstract
BACKGROUND: Despite international commitment to Millennium Development Goal 5, maternal mortality remains high in low- and middle-income countries (LMICs) of sub-Saharan Africa. This is in part due to infrastructure gaps, including availability of intensive care units (ICUs). We sought to use obstetric ICU utilization as a marker of severe maternal morbidity and provide an initial characterization of its relationship with in-hospital mortality. METHODS: A prospective observational cohort study of all obstetric subjects admitted to the ICU of Kamuzu Central Hospital in Malawi from September 2016 to March 2018. We reviewed charts at the time of ICU admission to assess the indication for admission, clinical characteristics and laboratory values. Subjects were followed until death or discharge. The primary outcome was in-hospital mortality. RESULTS: One-hundred-and-five obstetric patients were admitted to the study ICU (23% of all admissions). The median age was 26 years. The majority (79%) had undergone recent surgery; 40 (52%) an abdominal postnatal or cesarean hysterectomy and 31 (40%) a cesarean delivery without hysterectomy. Ninety-five percent required mechanical ventilation and 48% required vasopressors. Overall in-hospital mortality was 49%. CONCLUSIONS: The proportion of obstetric subjects admitted to the ICU in Malawi is nearly 1 in 4, which exceeds that found in high-income countries by orders of magnitude. Intensive care unit admission was associated with high mortality in this population. Investments in improving infrastructure and care gaps may include addressing available ICU bed and blood-banking needs, and increasing the number of providers trained in managing critical illness among obstetric patients.
BACKGROUND: Despite international commitment to Millennium Development Goal 5, maternal mortality remains high in low- and middle-income countries (LMICs) of sub-Saharan Africa. This is in part due to infrastructure gaps, including availability of intensive care units (ICUs). We sought to use obstetric ICU utilization as a marker of severe maternal morbidity and provide an initial characterization of its relationship with in-hospital mortality. METHODS: A prospective observational cohort study of all obstetric subjects admitted to the ICU of Kamuzu Central Hospital in Malawi from September 2016 to March 2018. We reviewed charts at the time of ICU admission to assess the indication for admission, clinical characteristics and laboratory values. Subjects were followed until death or discharge. The primary outcome was in-hospital mortality. RESULTS: One-hundred-and-five obstetric patients were admitted to the study ICU (23% of all admissions). The median age was 26 years. The majority (79%) had undergone recent surgery; 40 (52%) an abdominal postnatal or cesarean hysterectomy and 31 (40%) a cesarean delivery without hysterectomy. Ninety-five percent required mechanical ventilation and 48% required vasopressors. Overall in-hospital mortality was 49%. CONCLUSIONS: The proportion of obstetric subjects admitted to the ICU in Malawi is nearly 1 in 4, which exceeds that found in high-income countries by orders of magnitude. Intensive care unit admission was associated with high mortality in this population. Investments in improving infrastructure and care gaps may include addressing available ICU bed and blood-banking needs, and increasing the number of providers trained in managing critical illness among obstetric patients.
Authors: Jan L Keizer; Joost J Zwart; Robertjan H Meerman; Bert I J Harinck; Hans D M Feuth; Jos van Roosmalen Journal: Eur J Obstet Gynecol Reprod Biol Date: 2006-01-27 Impact factor: 2.435
Authors: Jared Tomlinson; Bryce Haac; Clement Kadyaudzu; Jonathan C Samuel; Emilia L P Campbell; Clara N Lee; Anthony G Charles Journal: Trop Doct Date: 2013-03-14 Impact factor: 0.731
Authors: 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 Journal: PLoS One Date: 2021-12-31 Impact factor: 3.240