Indications, prevalence, predictors of mortality and outcome of admissions to maternity intensive care unit among critically ill women admitted at Muhimbili National Hospital, Dar es salaam

Abstract

ABSTRACT Background; maternal mortality remains a significant public health challenge, particularly in low-resource settings, where it is often linked to critical maternal conditions requiring intensive care. Pregnancy-related complications such as hypertensive disorders, severe hemorrhage, sepsis, and cardiac complications can escalate rapidly, leading to life-threatening situations. Prompt access to intensive care unit (ICU) services is crucial for managing such critically ill obstetric patients, as it provides advanced monitoring and life-saving interventions. However, delays in recognizing critical illness, seeking care, and accessing specialized ICU services contribute to poor outcomes, including high maternal mortality. In many developing countries, including Tanzania, maternal ICU admissions are rare but associated with high mortality rates, reflecting the severity of the cases admitted. Muhimbili National Hospital (MNH), a tertiary referral center, plays a pivotal role in managing critically ill pregnant and postpartum women, making it an ideal setting to study the prevalence, indications, outcomes, and predictors of mortality among maternity ICU patients. Understanding these factors is essential for developing strategies to reduce maternal deaths and improve obstetric critical care. Study objective; to determine the prevalence of maternity ICU admission, indications, maternal outcomes, and predictors of mortality after admission to maternity ICU among critically ill obstetric patients admitted at MNH, Dar es Salaam from January 2020 to December 2022. Methods; this was an analytical hospital-based cross-sectional study. Data was collected by retrieving medical records from the labor ward, and ICU registry and cross-checking with the hospital's electronic database, then retrieving files from medical records. Descriptive statistics was presented as frequencies, proportions, percentages, mean with standard deviation, and median with range and charts. The primary outcome variable was the outcome of the critically ill obstetric patients upon exiting from the ICU. Multiple regression analysis was employed to generate hazard ratios for relations with the participants’ indications of admission to maternity ICU, demographics, and clinical characteristics. Results: A total of 187(0.7% of all maternity admissions) women were admitted to maternity ICU, 73.3% (137/187) died, and sepsis being the leading cause of death (24.1%). The median age was 33 years and the IQR of 28-38 years. The majority (92.2%) were referral cases, more than half of them (65.8%) were postpartum, (and 51.9%) had vaginal delivery. Hypertensive Disorders of Pregnancy was the most common indication prompting ICU admission, accounting for (26.7% of all admissions). Women admitted to ICU were more likely to die if their indication for ICU admission were sepsis, respiratory complications, and cardiac complications Conclusion: hypertensive disorders of pregnancy (HDP) were the most common reason for ICU admission, followed by respiratory and neurological complications. However, the majority of patients admitted to the maternity ICU died, with sepsis as the leading cause of death, followed by pneumonia and cardiac diseases. The high mortality rate reflects delays in care and severe conditions at admission, emphasizing the need for timely referrals, infection control, and strengthened icu services. Improving infrastructure, staffing, and multidisciplinary care is essential to reduce maternal deaths and enhance critical care outcomes.