Indications, Clinical Characteristics, Management and Outcome of Patients Admitted to a Newly Dedicated Obstetrics Intensive Care Unit at the Kenyatta National Hospital: Descreptive Retrospective Cohort Study

Abstract

Background: Admission to critical care units has been shown to be a maker of severe morbidity. Critically ill obstetric patients are often admitted to non-dedicated intensive care units rather than to dedicated obstetric ICU. Studies have shown better outcome when obstetric patients are admitted to dedicated rather than integrated intensive care units. Kenyatta National Hospital (KNH) recently opened a dedicated obstetric ICU and this study sought to provide baseline data aimed at improving outcomes. Objective: To determine the indications, clinical characteristics, management and outcomes of patients admitted to the dedicated obstetrics ICU at KNH between March 2020 to February 2021. Methodology: Using a retrospective descriptive cohort study design, data was retrieved from 182 patients’ files that met the inclusion criteria. SPSS version 26 was used to analyse data. Descriptive statistics such as means and standard deviations were used for continuous variables and frequencies and percentages for categorical variables. Mortality was calculated as a proportion of deaths among the population and presented as percentage. Chi-square test was used for categorical variables to determine factors associated with mortality. A p-value of <0.005 was taken to be statistically significant. Further multivariate logistic regression analysis was done for factors associated with mortality. Results: A total of 182 files of the admissions were analysed in the study and the mean age was 28 years. Majority were married(n=144), unemployed(n=107), multiparous(n=134), urban-dwellers(n=112) and referrals(n=141). The most common indication for admission was hypertensive diseases of pregnancy (54%). CVC insertion (n=122,67%) and mechanical ventilation (n=107,59%) were the most common interventions. The average duration of stay was 5 days. Maternal mortality rate was at 29%. Majority ,93%, of mortalities were referrals. Factors associated with mortality: caesarean section delivery aOR4.47(1.14,17.57), mechanical ventilation aOR4.00(1.08,14.81) and central venous catheter insertion aOR8.18(1.52,44.15) which are likely procedures on critically ill patients in ICU. Conclusion: Most of the patients admitted to the ICU would benefit from HDU care and further research on comparison of ICU outcome with disease severity score at admission is recommended.