Factors associated with the clinical outcomes of maternal Intensive Care Unit admission following obstetric surgeries at Muhimbili National Hospital, Tanzania: a cross-sectional study.

ABSTRACT Maternal ICU admission provides advanced, lifesaving medical care for pregnant or postpartum women who are critically ill. The burden of obstetric critical illness requiring ICU admission is higher in low- and middle-income countries (LMICs) than in high-income countries. Most critically ill obstetric patients admitted to the ICU have undergone major surgical interventions such as caesarean sections, hysterectomies and explorative laparotomies. Common indications for maternal ICU admission following surgery include postpartum hemorrhage (PPH), hypertensive disorders of pregnancy, and sepsis. Maternal ICU admission following obstetric surgery is associated with high maternal mortality, prolonged ICU stay, and poor neonatal outcomes. Identifying factors associated with poor maternal outcomes after ICU admission following obstetrics surgeries is essential for reducing preventable severe morbidity and mortality. This study aimed to assess the factors associated with the clinical outcomes of maternal ICU admissions following obstetric surgery at Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania. This was a prospective cross-sectional study, conducted at the MNH, Obstetrics ICU, involving 115 women admitted following obstetric surgery. Data were collected using a modified WHO maternal near-miss checklist. Data were analyzed using SPSS version 27. Categorical variables were summarized using frequencies and percentages, and continuous variables were summarized using median and interquartile range (IQR). The associations between variables were assessed using Pearson’s chi-square and Fisher’s exact tests. Modified Poisson regression analysis was used to determine the strength of associations, with statistical significance set at p < 0.05 and 95% confidence interval. PPH was the most common indication for maternal ICU admission following surgery, accounting for 46.1% of admissions. The overall maternal ICU mortality was 16.5%, whereas 40.9% of patients experienced prolonged ICU stays. In bivariate analysis, mechanical ventilation (p = 0.04) and use of inotropes and/or vasopressors (p = 0.022) were significantly associated with maternal mortality, while mechanical ventilation (p = 0.025), PPH (p = 0.031), and blood and/or blood products transfusion (p = 0.003) were significantly associated with prolonged ICU stay. In the modified Poisson regression analysis, mechanical ventilation (adjusted prevalence ratio [aPR] = 2.3; 95% CI: 1.11–4.64; p = 0.025) and blood and/or blood product transfusion (aPR = 1.9; 95% CI: 1.23–2.80; p = 0.003) were independently and significantly associated with prolonged ICU stay. This study demonstrates that PPH was the most common indication for maternal ICU admission following obstetric surgery. The overall maternal mortality was 16.5% with 40.9% of patients experience prolonged ICU stay. The need for mechanical ventilation, vasoactive support and blood transfusion were significantly associated with poor maternal outcomes. Healthcare providers should strengthen antenatal identification and correction of risk factors for PPH, including anaemia, previous PPH, multiple pregnancy, and hypertensive disorders of pregnancy during antenatal care visits (ANC); ensure appropriate prophylactic uterotonics administration during delivery; and promote early detection and timely, multidisciplinary management of PPH to reduce severe maternal morbidity, ICU admission, and maternal mortality. In addition, hospital management should strengthen early recognition and timely management of critically ill obstetric patients to reduce maternal mortality and prolonged ICU stay.