Factors associated with maternal death in women admitted to an intensive care unit with severe maternal morbidity

Abstract

Objective: To identify factors associated with maternal death among women with severe maternal morbidity. Methods: A retrospective study of 673 women admitted to an obstetric intensive care unit was undertaken. The odds ratios (OR) and 95% confidence intervals (95% CI) were calculated for selected characteristics. The maternal mortality and severe maternal morbidity ratios were determined for groups of complications according to outcome (death or survival). Results: The risk of maternal death was higher among adolescents (OR 3.3; 95% Cl, 1-9.7) and patients referred from other hospitals (OR 9.8: 95% Cl, 2.7-53.3). The severe maternal morbidity ratio was 46.6 per 1000 deliveries and the mortality:morbidity ratio 1:37.4. Obstetric complications led to 65.8% of admissions and 50% of maternal deaths. The number of interventions/procedures and total maximum sequential organ failure assessment score were higher in cases of death. Conclusion: The Strong association between interhospital transfer and maternal death suggests delays in diagnosis, management, and referral. Adopting organ dysfunction-based criteria may contribute toward identifying the most severe cases. (C) 2009 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.