Predictors Of Admissions Among Obstetric Patients At The Critical Care Unit, Kenyatta National Hospital

Abstract

Background: World Health Organization (WHO) describes severe maternal morbidity as near death (near miss) but survival from complications which occurred during pregnancy, childbirth or within 42 days of termination of pregnancy(1). Maternal morbidity and mortality is tragic, since pregnant women are generally young and healthy patients. Pregnancy, delivery and pueperium can be complicated by maternal morbidity therefore necessitating admission to a Critical Care Unit (CCU). Transfer to the CCU is usually one of the indicators of maternal morbidity(2). Pregnancy is associated with significant physiological changes which may complicate the management of a critically ill patient. It is, therefore, necessary for both the patient and the care giver to understand these changes(3). Various factors could lead to delayed diagnosis and treatment of a complication such as; delay in access to fully equipped facility, poor ante-natal screening, low socio-economic status and lack of education(4) . Objective: To determine the predictive factors leading to admissions of critically ill obstetric patients after delivery from 24 weeks gestation to 6 weeks post-partum into the CCU. Methods: This was a prospective case-control study among obstetric patients from 24 weeks gestation to 6 weeks post-partum admitted in the Critical Care Unit (CCU) after delivery. Cases were recruited in the CCU and the controls were obstetric patients after delivery admitted in the labour ward. Controls were unmatched with the cases and were chosen after the indexed case. The presence of risk factors is rare in the general population of obstetric patients in the labour ward. Data was extracted from the patient files and additional information obtained from the patients. Statistical analysis was done in SPSS version 21.0 and the risk factors associated with CCU admission determined using odds ratios with p values at 5% level of significance. We used logistic regression to analyze the predictors of CCU admission. The study findings are hereby presented using figures, tables, pie-charts and bar-graphs. Results: The study showed that an increase in pre-pregnancy Body Mass Index was a contributing risk factor for admission into the CCU. An increase in gestational age was protective, hence reducing the chance of being admitted into the CCU. The two commonest indications for admission were severe eclampsia and obstetric hemorrhage.