Epidemiology, Outcomes, and Risk Factors for Mortality in Critically Ill Women Admitted to an Obstetric High-Dependency Unit in Sierra Leone

• Published in: The American journal of tropical medicine and hygiene 2020-11, Vol.103 (5), p.2142-2148
• Main Authors: Marotta, Claudia, Pisani, Luigi, Di Gennaro, Francesco, Cavallin, Francesco, Bah, Sarjoh, Pisani, Vincenzo, Haniffa, Rashan, Beane, Abi, Trevisanuto, Daniele, Hanciles, Eva, Schultz, Marcus J, Koroma, Michael M, Putoto, Giovanni
• Format: Article
• Language: English
• Subjects: Adult; Critical Care - organization & administration; Critical Illness - epidemiology; Critical Illness - mortality; Epidemiology; Female; Hospitalization; Humans; Intensive Care Units; Maternal mortality; Mortality; Obstetrics; Patient Admission; Pregnancy; Retrospective Studies; Risk Factors; Sierra Leone - epidemiology; Vital signs; Young Adult
• ISSN: 0002-9637; 1476-1645
• DOI: 10.4269/ajtmh.20-0623

A better understanding of the context-specific epidemiology, outcomes, and risk factors for death of critically ill parturients in resource-poor hospitals is needed to tackle the still alarming in-hospital maternal mortality in African countries. From October 2017 to October 2018, we performed a 1-year retrospective cohort study in a referral maternity hospital in Freetown, Sierra Leone. The primary endpoint was the association between risk factors and high-dependency unit (HDU) mortality. Five hundred twenty-three patients (median age 25 years, interquartile range [IQR]: 21-30 years) were admitted to the HDU for a median of 2 (IQR: 1-3) days. Among them, 65% were referred with a red obstetric early warning score (OEWS) code, representing 1.17 cases per HDU bed per week; 11% of patients died in HDU, mostly in the first 24 hours from admission. The factors independently associated with HDU mortality were ward rather than postoperative referrals (odds ratio [OR]: 3.21; 95% CI: 1.48-7.01; = 0.003); admissions with red (high impairment of patients' vital signs) versus yellow (impairment of vital signs) or green (little or no impairment of patients' vital signs) OEWS (OR: 3.66; 95% CI: 1.15-16.96; = 0.04); responsiveness to pain or unresponsiveness on the alert, voice, pain unresponsive scale (OR: 5.25; 95% CI: 2.64-10.94; ≤ 0.0001); and use of vasopressors (OR: 3.24; 95% CI: 1.32-7.66; = 0.008). Critically ill parturients were predominantly referred with a red OEWS code and usually required intermediate care for 48 hours. Despite the provided interventions, death in the HDU was frequent, affecting one of 10 critically ill parturients. Medical admission, a red OEWS code, and a poor neurological and hemodynamic status were independently associated with mortality, whereas adequate oxygenation was associated with survival.