Obstetric ICU Admissions and In-Hospital Maternal Outcomes at a Specialized Women’s Hospital in Uganda

Abstract

Background: Obstetric intensive care provides essential organ support for women with severe pregnancy-related complications. Reviewing ICU admissions can identify patterns of morbidity, treatment and in-hospital maternal outcomes. Objective: To describe obstetric conditions, interventions and in-hospital outcomes among ICU admissions over four years, and to explore factors associated with recorded in-hospital death. Methods: We reviewed 261 obstetric ICU admission records at Mulago Specialized Women and Neonatal Hospital from 1 July 2019 to 30 June 2023. Crude odds ratios (ORs) and 95% confidence intervals (CIs) were calculated from available exposure and outcome data. An exploratory logistic model included 11 specified covariates and 241 complete records. Results: Mean age was 28.6 ± 6.6 years among 252 admission records, and 224/261 (85.8%) were referrals. Severe pre-eclampsia (55, 21.1%), severe postpartum hemorrhage (50, 19.2%) and sepsis or severe systemic infection (43, 16.5%) were frequently recorded obstetric syndromes. Among 253 admissions with a documented outcome, 102 (40.3%) recorded in-hospital death. In the complete-record model, ventilation or intubation ≥60 minutes (AOR 10.95, 95% CI 5.09-23.58), shock (6.76, 2.66-17.21) and sepsis or severe systemic infection (3.42, 1.29-9.06) were associated with higher odds of death. Transfusion ≥5 units was associated with lower odds (0.31, 0.10–0.97). Conclusion: In-hospital mortality was high among obstetric ICU admissions with documented outcomes. Shock, prolonged ventilation and sepsis or severe infection were associated with higher odds of death; treatment associations cannot establish benefit or harm. The findings support focused audit of recognition, resuscitation and referral processes, with validation of episode identity and coding before service-wide inference.