Publication: Epidemiology, outcomes, and risk factors for mortality in critically ill women admitted to an obstetric high-dependency unit in sierra leone
Issued Date
2020-01-01
Resource Type
ISSN
14761645
00029637
00029637
Other identifier(s)
2-s2.0-85095975038
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Mahidol University
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SCOPUS
Bibliographic Citation
American Journal of Tropical Medicine and Hygiene. Vol.103, No.5 (2020), 2142-2148
Suggested Citation
Claudia Marotta, Luigi Pisani, Francesco Di Gennaro, Francesco Cavallin, Sarjoh Bah, Vincenzo Pisani, Rashan Haniffa, Abi Beane, Daniele Trevisanuto, Eva Hanciles, Marcus J. Schultz, Michael M. Koroma, Giovanni Putoto Epidemiology, outcomes, and risk factors for mortality in critically ill women admitted to an obstetric high-dependency unit in sierra leone. American Journal of Tropical Medicine and Hygiene. Vol.103, No.5 (2020), 2142-2148. doi:10.4269/ajtmh.20-0623 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/60502
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Title
Epidemiology, outcomes, and risk factors for mortality in critically ill women admitted to an obstetric high-dependency unit in sierra leone
Abstract
© 2020 by The American Society of Tropical Medicine and Hygiene. 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 highdependency 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 perHDUbed 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; P = 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; P = 0.04); responsiveness to pain or unresponsiveness on the alert, voice, pain unresponsive scale (OR: 5.25; 95% CI: 2.64-10.94; P £ 0.0001); and use of vasopressors (OR: 3.24; 95% CI: 1.32-7.66; P = 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 theHDUwas 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.