Predictors of maternal mortality among critically ill obstetric patients|
Adeniran, A. S.; Bolaji, B. O.; Fawole, A. A. & Oyedepo, O. O.
Evaluation of the predictors of maternal mortality among critically ill
obstetric patients managed at the intensive care unit (ICU).
A case control study to evaluate the predictors of maternal mortality
among critically ill obstetric patients managed at the intensive care unit
(ICU) of the University of Ilorin Teaching Hospital, Ilorin, Nigeria from
1st January 2010 to 30th June 2013. Participants were critically ill obstetric
patients who were admitted and managed at the ICU during the study
period. Subjects were those who died while controls were age and parity
matched survivors. Statistical analysis was with SPSS-20 to determine chi
square, Cox-regression and odds ratio; p value < 0.05 was significant.
The mean age of subjects and controls were 28.92 ± 5.09 versus 29.44
± 5.74 (p = 0.736), the level of education was higher among controls (p
= 0.048) while more subjects were of low social class (p = 0.321), did
not have antenatal care (p = 0.131) and had partners with lower level of
education (p = 0.156) compared to controls. The two leading indications
for admission among subjects and controls were massive postpartum
haemorrhage and severe preeclampsia or eclampsia. The mean duration
of admission was higher among controls (3.32 ± 2.46 versus 3.00 ± 2.58;
p = 0.656) while the mean cost of ICU care was higher among the subjects
(p = 0.472). The statistical significant predictors of maternal deaths were
the patient’s level of education, Glasgow Coma Scale (GCS) score, oxygen
saturation, multiple organ failure at ICU admission and the need for
mechanical ventilation or inotrophic drugs after admission.
The clinical state at ICU admission of the critically ill obstetric patients is
the major outcome determinant. Therefore, early recognition of the need
for ICU care, adequate pre-ICU admission supportive care and prompt
transfer will improve the outcome.