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

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  • 1 Section of Operational Research, Doctors with Africa Cuamm, Padova, Italy;
  • | 2 Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands;
  • | 3 Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand;
  • | 4 Independent Statistician, Solagna, Italy;
  • | 5 Princess Christian Maternity Hospital, Doctor with Africa CUAMM, Freetown, Sierra Leone;
  • | 6 Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka;
  • | 7 Department of Woman’s and Child’s Health, University of Padua, Padua, Italy;
  • | 8 Department of Anesthesia and Intensive Care, University of Sierra Leone, Freetown, Sierra Leone

ABSTRACT

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; 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 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.

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Author Notes

Address correspondence to Francesco Di Gennaro, Section of Operational Research, Doctors with Africa Cuamm, Via San Francesco, 126, 35121 Padova, Italy. E-mail: cicciodigennaro@yahoo.it

Disclosure: The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

Authors’ addresses: Claudia Marotta, Francesco Di Gennaro, and Giovanni Putoto, Section of Operational Research, Doctors with Africa Cuamm, Padova, Italy, E-mails: marotta.claudia@gmail.com, cicciodigennaro@yahoo.it, and g.putoto@cuamm.org. Luigi Pisani, Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands, and Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand, E-mail: luigipisani@gmail.com Marcus J. Schultz, Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands, Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand, and Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka, E-mail: marcus.j.schultz@gmail.com. Francesco Cavallin, Independent Statistician, Solagna, Italy, E-mail: cescocava@libero.it. Sarjoh Bah and Vincenzo Pisani, Princess Christian Maternity Hospital, Doctor with Africa CUAMM, Freetown, Sierra Leone, E-mails: sarjbah20@gmail.com and enzopisani@gmail.com. Rashan Haniffa and Abi Beane, Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand, and Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka, E-mails: rashan@nicslk.com and abi@nicslk.com. Daniele Trevisanuto, Department of Woman’s and Child’s Health, University of Padua, Padua, Italy, E-mail: daniele.trevisanuto@gmail.com. Eva Hanciles and Michael M. Koroma, Department of Anesthesia and Intensive Care, University of Sierra Leone, Freetown, Sierra Leone, E-mails: ehanchris@yahoo.co.uk and pcmhmonitoringoffice@gmail.com.

These authors contributed equally to the study.

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