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Ayala Quintanilla BP, Taft A, McDonald S, Pollock W, Roque Henriquez JC. Social determinants and exposure to intimate partner violence in women with severe acute maternal morbidity in the intensive care unit: a systematic review. BMC Pregnancy Childbirth 2023; 23:656. [PMID: 37700244 PMCID: PMC10496274 DOI: 10.1186/s12884-023-05927-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 08/16/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Studying severe acute maternal morbidity in the intensive care unit improves our understanding of potential factors affecting maternal health. AIM To review evidence on maternal exposure to intimate partner violence and social determinants of health in women with severe acute maternal morbidity in the intensive care unit. METHODS The protocol for this review was registered in PROSPERO (registration number CRD42016037492). A systematic search was performed in MEDLINE, CINAHL, ProQuest, LILACS and SciELO using the search terms "intensive care unit", "intensive care", "critical care" and "critically ill" in combination with "intimate partner violence", "social determinants of health", "severe acute maternal morbidity", pregnancy, postpartum and other similar terms. Eligible studies were (i) quantitative, (ii) published in English and Spanish, (iii) from 2000 to 2021, (iv) with data related to intimate partner violence and/or social determinants of health, and (v) investigating severe acute maternal morbidity (maternity patients treated in the intensive care unit during pregnancy, childbirth or within 42 days of pregnancy termination). Of 52,866 studies initially identified, 1087 full texts were assessed and 156 studies included. Studies were independently assessed by two reviewers for screening, revision, quality assessment and abstracted data. Studies were categorised into high/middle/low-income countries and summarised data were presented using a narrative description, due to heterogenic data as: (i) exposure to intimate partner violence and (ii) social determinants of health. RESULTS One study assessed intimate partner violence among mothers with severe acute maternal morbidity in the intensive care unit and found that women exposed to intimate partner violence before and during pregnancy had a nearly four-fold risk of severe acute maternal morbidity requiring ICU admission. Few social determinants of health other than age were reported in most studies. CONCLUSION This review identified a significant gap in knowledge concerning intimate partner violence and social determinants of health in women with severe acute maternal morbidity in the intensive care unit, which is essential to better understand the complete picture of the maternal morbidity spectrum and reduce maternal mortality.
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Affiliation(s)
- Beatriz Paulina Ayala Quintanilla
- School of Nursing and Midwifery, The Judith Lumley Centre, La Trobe University, Plenty Road & Kingsbury Drive, Level 3, George Singer Building, Bundoora, Melbourne, VIC, Australia.
- Universidad de San Martin de Porres, La Molina, Lima, Peru.
| | - Angela Taft
- School of Nursing and Midwifery, The Judith Lumley Centre, La Trobe University, Plenty Road & Kingsbury Drive, Level 3, George Singer Building, Bundoora, Melbourne, VIC, Australia
| | - Susan McDonald
- School of Nursing and Midwifery, The Judith Lumley Centre, La Trobe University, Plenty Road & Kingsbury Drive, Level 3, George Singer Building, Bundoora, Melbourne, VIC, Australia
| | - Wendy Pollock
- School of Nursing and Midwifery, The Judith Lumley Centre, La Trobe University, Plenty Road & Kingsbury Drive, Level 3, George Singer Building, Bundoora, Melbourne, VIC, Australia
- Nursing and Midwifery, Monash University, Melbourne, VIC, Australia
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Ali Egal J, Essa A, Osman F, Klingberg-Allvin M, Erlandsson K. Facility-based maternal deaths: Their prevalence, causes and underlying circumstances. A mixed method study from the national referral hospital of Somaliland. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 37:100862. [PMID: 37269618 DOI: 10.1016/j.srhc.2023.100862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 05/01/2023] [Accepted: 05/24/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Somaliland has one of the highest rates of maternal deaths in the world. An estimated 732 women die for every 100,000 live births. This study aims to identify the prevalence of facility-based maternal deaths, the causes and their underlying circumstances by interviewing relatives and health care providers at the main referral hospital. METHOD A hospital-based mixed method study. The prospective cross-sectional design of the WHO Maternal Near Miss tool was combined with narrative interviews with 28 relatives and 28 health care providers in direct contact with maternal deaths. The quantitative data was analysed with descriptive statistics using SPSS and the qualitative part of the study was analysed with content analysis using NVivo. RESULTS From the 6658 women included 28 women died. The highest direct cause of maternal death was severe obstetric haemorrhage (46.4%), followed by hypertensive disorders (25%) and severe sepsis (10.7%). An indirect obstetric cause of death was medical complications (17.9%). Twenty-five per cent of these cases were admitted to ICU and 89% had referred themselves to the hospital for treatment. The qualitative data identifies two categories of missed opportunities that could have prevented these maternal mortalities: poor risk awareness in the community and inadequate interprofessional collaboration at the hospital. CONCLUSION The referral system needs to be strengthened utilizing Traditional Birth Attendants as community resource supporting the community facilities. The communication skills and interprofessional collaboration of the health care providers at the hospital needs to be addressed and a national maternal death surveillance system needs to be commenced.
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Affiliation(s)
- Jama Ali Egal
- School of Health and Welfare, Dalarna University, Sweden.
| | - Amina Essa
- Department of Midwifery, University of Hargeisa, Somaliland.
| | - Fatumo Osman
- School of Health and Welfare, Dalarna University, Sweden.
| | - Marie Klingberg-Allvin
- School of Health and Welfare, Dalarna University, Sweden; Department of Women and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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Bowker SL, Williams K, Volk A, Auger L, Lafontaine A, Dumont P, Wingert A, Davis A, Bialy L, Wright E, Oster RT, Bagshaw SM. Incidence and outcomes of critical illness in indigenous peoples: a systematic review and meta-analysis. Crit Care 2023; 27:285. [PMID: 37443118 PMCID: PMC10339531 DOI: 10.1186/s13054-023-04570-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/07/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Indigenous Peoples experience health inequities and racism across the continuum of health services. We performed a systematic review and meta-analysis of the incidence and outcomes of critical illness among Indigenous Peoples. METHODS We searched Ovid MEDLINE/PubMed, Ovid EMBASE, Google Scholar, and Cochrane Central Register of Controlled Trials (inception to October 2022). Observational studies, case series of > 100 patients, clinical trial arms, and grey literature reports of Indigenous adults were eligible. We assessed risk of bias using the Newcastle-Ottawa Scale and appraised research quality from an Indigenous perspective using the Aboriginal and Torres Strait Islander Quality Assessment Tool. ICU mortality, ICU length of stay, and invasive mechanical ventilation (IMV) were compared using risk ratios and mean difference (MD) for dichotomous and continuous outcomes, respectively. ICU admission was synthesized descriptively. RESULTS Fifteen studies (Australia and/or New Zealand [n = 12] and Canada [n = 3]) were included. Risk of bias was low in 10 studies and moderate in 5, and included studies had minimal incorporation of Indigenous perspectives or consultation. There was no difference in ICU mortality between Indigenous and non-Indigenous (RR 1.14, 95%CI 0.98 to 1.34, I2 = 87%). We observed a shorter ICU length of stay among Indigenous (MD - 0.25; 95%CI, - 0.49 to - 0.00; I2 = 95%) and a higher use for IMV among non-Indigenous (RR 1.10; 95%CI, 1.06 to 1.15; I2 = 81%). CONCLUSION Research on Indigenous Peoples experience with critical care is poorly characterized and has rarely included Indigenous perspectives. ICU mortality between Indigenous and non-Indigenous populations was similar, while there was a shorter ICU length of stay and less mechanical ventilation use among Indigenous patients. Systematic Review Registration PROSPERO CRD42021254661; Registered: 12 June, 2021.
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Affiliation(s)
- Samantha L. Bowker
- Critical Care Strategic Clinical Network™, Alberta Health Services, 2-124 Clinical Science Building, 8440-112 Street NW, Edmonton, AB T6G 2B7 Canada
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, 2-124E Clinical Science Building, 8440-112 Street NW, Edmonton, AB T6G 2B7 Canada
| | - Kienan Williams
- Indigenous Wellness Core, Alberta Health Services, 10301 Southport Lane SW, Calgary, AB T2W 1S7 Canada
| | - Auriele Volk
- Indigenous Medical and Dental Students Association, Faculty of Medicine and Dentistry, University of Alberta, Katz Group Centre for Pharmacy and Health Research, 1-002, Edmonton, AB T6G 2E1 Canada
- Indigenous Peoples and Critical Care in Alberta Advisory Committee, Faculty of Medicine and Dentistry, University of Alberta, 2-124 Clinical Science Building, 8440-112 Street NW, Edmonton, AB T6G 2B7 Canada
| | - Leonard Auger
- Indigenous Peoples and Critical Care in Alberta Advisory Committee, Faculty of Medicine and Dentistry, University of Alberta, 2-124 Clinical Science Building, 8440-112 Street NW, Edmonton, AB T6G 2B7 Canada
| | - Alika Lafontaine
- Indigenous Peoples and Critical Care in Alberta Advisory Committee, Faculty of Medicine and Dentistry, University of Alberta, 2-124 Clinical Science Building, 8440-112 Street NW, Edmonton, AB T6G 2B7 Canada
| | - Paige Dumont
- Indigenous Peoples and Critical Care in Alberta Advisory Committee, Faculty of Medicine and Dentistry, University of Alberta, 2-124 Clinical Science Building, 8440-112 Street NW, Edmonton, AB T6G 2B7 Canada
| | - Aireen Wingert
- Alberta Research Centre for Health Evidence, University of Alberta, Room 4-496A, Edmonton Clinic Health Academic, 11405 – 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Amanda Davis
- Indigenous Wellness Core, Alberta Health Services, 10301 Southport Lane SW, Calgary, AB T2W 1S7 Canada
| | - Liza Bialy
- Alberta Research Centre for Health Evidence, University of Alberta, Room 4-496A, Edmonton Clinic Health Academic, 11405 – 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Erica Wright
- Alberta Research Centre for Health Evidence, University of Alberta, Room 4-496A, Edmonton Clinic Health Academic, 11405 – 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Richard T. Oster
- Indigenous Wellness Core, Alberta Health Services, 10301 Southport Lane SW, Calgary, AB T2W 1S7 Canada
| | - Sean M. Bagshaw
- Critical Care Strategic Clinical Network™, Alberta Health Services, 2-124 Clinical Science Building, 8440-112 Street NW, Edmonton, AB T6G 2B7 Canada
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, 2-124E Clinical Science Building, 8440-112 Street NW, Edmonton, AB T6G 2B7 Canada
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Asaba H, Aoki Y, Akinaga C, Naruse S, Uchizaki S, Nakajima M, Doi M, Itoh H, Nakajima Y. Obstetric admission to intensive care units in Japan: a cohort study using the Japanese Intensive care PAtient Database. J Anesth 2023:10.1007/s00540-023-03200-9. [PMID: 37222956 DOI: 10.1007/s00540-023-03200-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 04/29/2023] [Indexed: 05/25/2023]
Abstract
PURPOSE This study aimed to describe the epidemiology and annual trends of obstetric patients using a multicenter intensive care database. METHODS This multicenter, retrospective cohort study used the Japanese Intensive care PAtient Database (JIPAD). We included obstetric patients registered in the JIPAD between 2015 and 2020. We investigated the proportion of obstetric patients among all patients in the intensive care unit (ICU). We also described the characteristics, procedures, and outcomes of obstetric patients. In addition, the annual trends were examined by nonparametric tests for trends. RESULTS Of the 184,705 patients enrolled in the JIPAD, 750 (0.41%) were obstetric patients from 61 facilities. The median age was 34 years, the number of post-emergency surgeries was 450 (60.0%), and the median APACHE III score was 36. Mechanical ventilation was the most common procedure performed in 247 (32.9%) patients. There were five (0.7%) in-hospital deaths. The proportion of obstetric patients in the ICU did not change between 2015 and 2020 (P for trend = 0.32). However, there was a trend for a significant decrease in the severity of illness and length of hospital stay on an annual basis between 2015 and 2020. Most patients were admitted to the ICU because of a pregnancy-related disorder postoperatively. CONCLUSION The proportion of obstetric patients was 0.41% of all ICU admissions. The proportion of obstetric patients admitted to the ICU did not change from 2015 to 2020, but the patients' severity of illness and length of hospital stay significantly decreased over time.
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Affiliation(s)
- Hitomi Asaba
- Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Yoshitaka Aoki
- Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, Shizuoka, 431-3192, Japan.
| | - Chieko Akinaga
- Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Satoshi Naruse
- Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Sakiko Uchizaki
- Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Mikio Nakajima
- Foundation for Ambulance Service Development, Emergency Life-Saving Technique Academy of Tokyo, Tokyo, Japan
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Matsuyuki Doi
- Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Hiroaki Itoh
- Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Yoshiki Nakajima
- Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, Shizuoka, 431-3192, Japan
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Davidson B, Bajpai D, Shah S, Jones E, Okyere P, Wearne N, Gumber R, Saxena N, Osafo C. Pregnancy-Associated Acute Kidney Injury in Low-Resource Settings: Progress Over the Last Decade. Semin Nephrol 2022; 42:151317. [PMID: 37011566 PMCID: PMC10986622 DOI: 10.1016/j.semnephrol.2023.151317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
Despite immense global effort, the maternal mortality rate in low-resource settings remains unacceptably high. Globally, this reflects the grave inequalities in access to health and reproductive services. Pregnancy-associated acute kidney injury (PRAKI) is an independent risk factor for mortality. The reported incidence of PRAKI in low- and middle-income countries is higher than that of high-income countries (4%-26% versus 1%-2.8%, respectively). Hypertensive disorders are now the leading cause of PRAKI in many regions, followed by hemorrhage and sepsis. PRAKI in low-resource settings carries a high mortality for both mother and child. Outcome studies suggest that PRAKI is associated with residual kidney dysfunction and may lead to dialysis dependence. This can be a death sentence in many regions with limited kidney replacement therapy. This review will summarize data on PRAKI on the African, Latin American, and Asian continents over the past decade. It will include the progress in published data, mortality, and treatment interventions and provide recommendations for the next decade.
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Affiliation(s)
- Bianca Davidson
- Department of Medicine, University of Cape Town, Cape Town, South Africa; Division of Hypertension and Nephrology, Groote Schuur Hospital, Cape Town, South Africa
| | - Divya Bajpai
- Department of Nephrology, Seth G.S.M.C. & K.E.M. Hospital, Mumbai, India
| | - Silvi Shah
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio, United States
| | - Erika Jones
- Department of Medicine, University of Cape Town, Cape Town, South Africa; Division of Hypertension and Nephrology, Groote Schuur Hospital, Cape Town, South Africa
| | - Perditer Okyere
- Department of Internal Medicine, School of Medicine and Dentistry, College of Health Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Nephrology Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Nicola Wearne
- Department of Medicine, University of Cape Town, Cape Town, South Africa; Division of Hypertension and Nephrology, Groote Schuur Hospital, Cape Town, South Africa
| | - Ramnika Gumber
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States
| | - Nikhil Saxena
- Department of Nephrology, Seth G.S.M.C. & K.E.M. Hospital, Mumbai, India
| | - Charlotte Osafo
- Department of Medicine and Therapeutics, University of Ghana Medical School, University of Ghana, Accra Ghana; Department of Nephrology, The Bank Hospital, Accra Ghana.
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An Integrated Review of Obstetric Admissions in the Intensive Care Unit. Dimens Crit Care Nurs 2022; 41:132-143. [PMID: 36749862 DOI: 10.1097/dcc.0000000000000521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Critically ill expectant mothers are regularly transferred from obstetrics units to an intensive care unit (ICU), placing one specialty population in an environment designed for another. OBJECTIVE The purpose of this study is to examine the rates of admission, admitting diagnoses, and mortality of obstetric intensive care patients in the United States and peer nations, and discuss implications to the critical care nurse. METHODS Relevant studies were identified in PubMed and Cumulative Index of Nursing and Allied Health Literature following strict eligibility criteria, including peer reviewed primary research, from 2010-2021, that examined rates of admissions, diagnoses, morbidity, and mortality of peripartum women requiring intensive care. Specialty ICU and countries with an overall performance score from the World Health Organization that placed them in the lower two-thirds deciles of all member countries were excluded. Fourteen articles, representing 9 countries, were reviewed by a single doctoral student. RESULTS Few obstetrics patients required intensive care. The majority of admissions and deaths occurred within the postpartum period. The most common admitting diagnoses were hemorrhage, hypertensive disorders of pregnancy, and sepsis. Mean mortality ranged from 0.2% to 9.7%. The most common causes of death were cardiovascular diseases and postpartum hemorrhage. DISCUSSION These women represent a truly specialized subset within the critical care population. Limitations include possible selection, confounding, and chronology biases; use of a single data extractor, and a relative dearth of relevant studies, originating in developed nations. CONCLUSIONS This review provided information on characteristics of the obstetric critical care population. Education and instituting early warning systems, formal debriefings, and standardization of protocols may assist in preparing critical care nurses in confidently caring for this population.
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Suri J, Khanam Z. Prognosticating Fetomaternal ICU Outcomes. Indian J Crit Care Med 2022; 25:S206-S222. [PMID: 35615605 PMCID: PMC9108782 DOI: 10.5005/jp-journals-10071-24022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Although no scoring system is as yet fully validated for predicting maternal outcomes in critically ill obstetric patients, prognostication may be done objectively using severity predicting models. General critical care scoring systems which have been studied in obstetric patients are outcome prediction models (Acute Physiology and Chronic Health Evaluation [APACHE] I-IV, Simplified Acute Physiology Score [SAPS] I-III, Mortality Probability Model [MPM] I-IV) and organ dysfunction scores (Multiple Organ Dysfunction Score [MODS], Logistic Organ Dysfunction Score [LODS], Sequential Organ Failure Assessment [SOFA]). General critical care scoring systems may overpredict mortality rates in obstetric patients secondary to an altered physiology of organ systems during pregnancy. Obstetric prediction models were developed keeping in mind the physiological characteristics of obstetric population. They are Modified Early Obstetric Warning System (MEOWS), Obstetric Early Warning Score (OEWS), Maternal Early Warning Trigger (MEWT), and disease-specific obstetric scoring systems. The APACHE II model and MPM II are most often used scoring systems for predicting maternal mortality. The SOFA model is the best predictive model for sepsis in obstetrics. APACHE II and SAPS are more useful for nonobstetric population. Recent studies have also underscored the applicability of the OEWS in intensive care unit (ICU) settings with results comparable to the more elaborate APACHE II and SOFA scores. The Early Warning System helps in identifying acutely deteriorating pregnant and postpartum women in non-ICU settings who may require critical care. Fetal outcomes are largely dependent upon maternal outcomes. Prognostic systems applied to mothers may help in estimation of perinatal mortality and morbidity.
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Affiliation(s)
- Jyotsna Suri
- Department of Obstetrics and Gynaecology, VMMC and Safdarjung Hospital, New Delhi, India
- Jyotsna Suri, Department of Obstetrics and Gynaecology, VMMC and Safdarjung Hospital, New Delhi, India, e-mail:
| | - Zeba Khanam
- Department of Obstetrics and Gynaecology, VMMC and Safdarjung Hospital, New Delhi, India
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Anane-Fenin B, Agbeno EK, Osarfo J, Opoku Anning DA, Boateng AS, Ken-Amoah S, Amanfo AO, Derkyi-Kwarteng L, Mouhajer M, Amoo SA, Ashong J, Jeffery E. A ten-year review of indications and outcomes of obstetric admissions to an intensive care unit in a low-resource country. PLoS One 2022; 16:e0261974. [PMID: 34972184 PMCID: PMC8719704 DOI: 10.1371/journal.pone.0261974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 12/14/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Obstetric intensive care unit admission (ICU) suggests severe morbidity. However, there is no available data on the subject in Ghana. This retrospective review was conducted to determine the indications for obstetric ICU admission, their outcomes and factors influencing these outcomes to aid continuous quality improvement in obstetric care. Methods This was a retrospective review conducted in a tertiary hospital in Ghana. Data on participant characteristics including age and whether participant was intubated were collected from patient records for all obstetric ICU admissions from 1st January 2010 to 31st December 2019. Descriptive statistics were presented as frequencies, proportions and charts. Hazard ratios were generated for relations between obstetric ICU admission outcome and participant characteristics. A p-value <0.05 was deemed statistically significant. Results There were 443 obstetric ICU admissions over the review period making up 25.7% of all ICU admissions. The commonest indications for obstetric ICU admissions were hypertensive disorders of pregnancy (70.4%, n = 312/443), hemorrhage (14.4%, n = 64/443) and sepsis (9.3%, n = 41/443). The case fatality rates for hypertension, hemorrhage, and sepsis were 17.6%, 37.5%, and 63.4% respectively. The obstetric ICU mortality rate was 26% (115/443) over the review period. Age ≥25 years and a need for mechanical ventilation carried increased mortality risks following ICU admission while surgery in the index pregnancy was associated with a reduced risk of death. Conclusion Hypertension, haemorrhage and sepsis are the leading indications for obstetric ICU admissions. Thus, preeclampsia screening and prevention, as well as intensifying antenatal education on the danger signs of pregnancy can minimize obstetric complications. The establishment of an obstetric HDU in CCTH and the strengthening of communication between specialists and the healthcare providers in the lower facilities, are also essential for improved pregnancy outcomes. Further studies are needed to better appreciate the wider issues underlying obstetric ICU admission outcomes. Plain language summary This was a review of the reasons for admitting severely-ill pregnant women and women who had delivered within the past 42 days to the intensive care unit (ICU), the admission outcomes and risk factors associated with ICU mortality in a tertiary hospital in a low-resource country. High blood pressure and its complications, bleeding and severe infections were observed as the three most significant reasons for ICU admissions in decreasing order of significance. Pre-existing medical conditions and those arising as a result of, or aggravated by pregnancy; obstructed labour and post-operative monitoring were the other reasons for ICU admission over the study period. Overall, 26% of the admitted patients died at the ICU and maternal age of at least 25 years and the need for intubation were identified as risk factors for ICU deaths. Attention must be paid to high blood pressure during pregnancy.
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Affiliation(s)
- Betty Anane-Fenin
- Department of Obstetrics and Gynaecology, Cape Coast Teaching Hospital, Cape Coast, Ghana
- * E-mail:
| | - Evans Kofi Agbeno
- Department of Obstetrics and Gynaecology, University of Cape Coast School of Medical Sciences, Cape Coast, Ghana
| | - Joseph Osarfo
- Department of Community Medicine, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | | | - Abigail Serwaa Boateng
- Department of Obstetrics and Gynaecology, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Sebastian Ken-Amoah
- Department of Obstetrics and Gynaecology, University of Cape Coast School of Medical Sciences, Cape Coast, Ghana
| | - Anthony Ofori Amanfo
- Department of Obstetrics and Gynaecology, University of Cape Coast School of Medical Sciences, Cape Coast, Ghana
| | - Leonard Derkyi-Kwarteng
- Department of Pathology, University of Cape Coast School of Medical Sciences, Cape Coast, Ghana
| | - Mohammed Mouhajer
- Department of Obstetrics and Gynaecology, University of Cape Coast School of Medical Sciences, Cape Coast, Ghana
| | - Sarah Ama Amoo
- Intensive Care Unit, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Joycelyn Ashong
- Department of Obstetrics and Gynaecology, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Ernestina Jeffery
- Intensive Care Unit, Cape Coast Teaching Hospital, Cape Coast, Ghana
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Ramlakhan KP, Gommers D, Jacobs CERM, Makouri K, Duvekot JJ, Reiss IKM, Franx A, Roos-Hesselink JW, Cornette JMJ. Women of reproductive age in a tertiary intensive care unit: indications, outcome and the impact of pregnancy-a retrospective cohort study. BMC WOMENS HEALTH 2021; 21:248. [PMID: 34147093 PMCID: PMC8214372 DOI: 10.1186/s12905-021-01396-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 05/31/2021] [Indexed: 08/26/2023]
Abstract
Background To evaluate the indications for admission and mortality rates of women of reproductive age admitted to a tertiary Intensive Care Unit (ICU) and to compare the outcomes of obstetric and non-obstetric admissions.
Methods
A retrospective cohort study was performed, including all women aged 17–41 years admitted to a level 3 ICU in the Netherlands, between January 1, 2000 and January 1, 2016. Primary outcome was indication for admission and mortality. Mortality, length of stay (LOS), need for mechanical ventilation and APACHE II score were compared between obstetric and non-obstetric admissions. The obstetric group was further analyzed for maternal and perinatal outcomes. Results 3461 women (median age 32 years) were included, with an overall mortality rate of 13.3%. The obstetric group consisted of 265 women (7.7%). The non-obstetric group (n = 3196) was admitted most often for cardiovascular disease (19.6%), followed by oncologic disease (15%). Mortality was the highest in women with oncologic disease (23.9%). The obstetric group had lower mortality compared to the non-obstetric group (4.9% vs. 14%, p < 0.001), despite higher APACHE II score (14 vs. 11, p < 0.001) and a higher ventilation rate (47.9% vs. 39%, p = 0.004). Major surgical or endovascular interventions, besides caesarean section, were performed in 46% of the obstetric group. Perinatal death occurred in 17.2% and of the surviving infants, 63.2% were born preterm and 45.1% required Neonatal Intensive Care Unit admission. Conclusions Cardiovascular disease is the most important indication for admission and oncologic disease is associated with highest mortality in women of reproductive age. Obstetric patients constitute a small percentage of all ICU admissions in a tertiary ICU center. They have lower mortality rates than non-obstetric young female patients, despite a more severe initial presentation. Nevertheless lasting maternal morbidity and perinatal mortality and morbidity is frequent.
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Affiliation(s)
- Karishma P Ramlakhan
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Diederik Gommers
- Department of Adult Intensive Care Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Carmen E R M Jacobs
- Department of Obstetrics and Gynecology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Khaoula Makouri
- Department of Obstetrics and Gynecology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Johannes J Duvekot
- Department of Obstetrics and Gynecology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Irwin K M Reiss
- Division of Neonatology, Department of Pediatrics, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Arie Franx
- Department of Obstetrics and Gynecology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jolien W Roos-Hesselink
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Jérôme M J Cornette
- Department of Obstetrics and Gynecology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
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