Obstetric admissions in intensive care units of University Teaching Hospitals of Butare and Kigali: Prevalence and outcomes

Abstract

Background: Reasons for obstetric admission in intensive care unit (ICU) vary from a setting to another and may depend on bed availability. Outcomes from ICU and its prediction models are not well explored in Rwanda because of lack of appropriate scores. This study intended to assess epidemiology and evaluate accuracy of mortality predictive tools for obstetric patients admitted in ICU.

Methods: We prospectively collected data from obstetric patients admitted in the two ICUs of public referral hospitals in Rwanda from 1st March 2017 to 28th February 2018 to identify reasons for admissions and factors for prognosis.

Results: In total, 747 cases were admitted to the two ICUs, and of them 94, (12.8%) admitted for obstetric reasons. These obstetric patients were drawn from 4,999 patients who delivered in obstetric departments of the two facilities, indicating that 1.8% of obstetric patients were admitted in ICU. The most common reasons for admission in ICU were respectively sepsis (31.9%), peripartum haemorrhage (25.5%). Mortality within ICU for these obstetric patients was 54.3% while the average length of stay was 6.6 days. When adjusted for reason for admission and Caesarean before admission, MEOWS was an independent predictor of mortality with adjusted OR of 1.25[1.07-1.46]; p=0.005. Similarly, one point of increase of qSOFA increased odds of ICU mortality by 181% [adj.OR:2.81[1.25-6.30]; p=0.012). The AUROC for MEOWS was 0.773[0.666-0.880]; p<0.0001 and 0.764[0.654-0.873]; p<0.0001 for qSOFA.

Conclusion: Sepsis is the most common reason for obstetric admissions to ICU with high risk for mortality in Rwanda. Modified Early Obstetric Warning Score (MEOWS) and qSOFA are good tools for ICU mortality prediction for obstetric patients but needs to be explored in a larger study