Utility in the obstetric high dependency unit and intensive care unit in tertiary medical center in Ethiopia: a comparative cross-sectional study

Abstract

Background: Globally, an estimated 10.7 million women have died due to obstetric complications in the last two decades, and two-thirds of these deaths occurred in sub-Saharan Africa. This study aims to assess the utility of the obstetric high dependency unit and intensive care unit and maternal outcome in a tertiary medical center in Ethiopia. Methods: A comparative cross-sectional study was conducted on critically ill obstetric clients admitted to St. Paul's Hospital Millennium medical college obstetric HDU from October 2020 to September 2022 and before the establishment of the obstetric HDU (who were admitted to the medical ICU). Binary and multivariate logistic regression was conducted to identify factors associated with maternal mortality before the establishment of the maternal HDU. Results: The minimum duration in both units was one day. The maximum duration was 14 days for HDU and 26 days for ICU. Following the establishment of the maternity HDU, the ICU admission rate decreased to 1.2 per 1000 deliveries. Obstetric patients diagnosed with DIC and HELLP syndrome upon admission to the ICU had a 4.9 times higher risk of mortality compared to their counterparts. Obstetric women admitted to the ICU and treated with inotropic agents or vasopressors had a 33.8 times higher risk of mortality compared to their counterparts. Conclusions: Obstetric admissions to the ICU significantly decreased following the establishment of the maternity HDU. Obstetric patients diagnosed with DIC and HELLP syndrome are more likely to develop unfavorably outcome.