Case Fatality Rate Among Preeclampsia/eclampsia Patients Admitted in Integrated Icu Versus Dedicated Obstetrics Icu in Kenyatta National Hospital From November 2017 to July 2022

Abstract

Background: • HDP has been found to be the most prevalent indication for ICU admission and one of the major causes of maternal mortality worldwide, majority of which occur in developing countries. Pre-eclampsia and eclampsia are the severest forms of HDP. Majority of these mortalities are preventable with timely and appropriate interventions one of which is provision of intensive/ critical care. Obstetric patients are a unique class of patients with special needs. This is due to factors such as: changes in physiology in pregnant women and that there are always two lives involved. The establishment of dedicated obstetrics CCU has been found to improve outcomes in critically ill obstetrics patients by a reduction in waiting time, avoidance of transportation accidents between wards/ theatre and ICU and provision of specialized care by obstetricians, critical care nurses, midwives and critical care doctors and continuous fetal monitoring in ANC mothers. KNH established a dedicated obstetrics CCU in 2020. The aim of this study is to therefore determine whether the inception of the dedicated obstetrics CCU at the KNH has led to improved outcomes among preeclampsia/eclampsia patients requiring ICU admission. Study Objective: To compare the case fatality rate among preeclampsia / eclampsia patients admitted to integrated ICU between November 2017 to February 2020 and obstetrics ICU between March 2020 to July 2022 in Kenyatta National Hospital. Methodology: This study was be a retrospective observational study of the pre and post type. It was conducted in KNH Health records department, integrated ICU and dedicated obstetrics ICU. The inclusion criteria will be preeclampsia/ eclampsia patients admitted in Integrated ICU between November 2017 to February 2020 and dedicated obstetrics ICU between March 2020 to July 2022. The intervention of interest was the establishment of a dedicated obstetrics ICU. The data on the sociodemographic details of the patient, the diagnosis, management, waiting time from decision to admit to ICU to admission to ICU, duration of stay in integrated ICU or obstetrics ICU and outcomes were collected from files retrieved from the records department. The fatality rate among the pre-eclampsia/eclampsia patients was identified for Main ICU group and for the Obstetrics ICU group. Then compared for any significant difference using the chi sq test. Sociodemographic and clinical characteristics of the patients were tabulated as frequencies and percentages for the categorical variables and means with standard deviations 12 for the continuous variables.Chi-square/Fisher’s exact test for categorical variables and student t-test / Mann Whitney test for continous variables.The data extracted was analysed using SPSS version 26. For all statistical tests,a p-value <0.05 was taken to be significant. Utility of the study: The obstetrics CCU in KNH is the first in the country therefore no study has been done to determine whether its establishment has resulted in better outcomes among patient with preeclampsia/eclampsia in KNH. The study findings may inform if there are improvements to be incorporated in the running of the dedicated CCU or further cement the need for dedicated CCUs in the country. The above knowledge will be highly valuable to those in policy and planning at KNH as well as on a national level.