Maternal outcome and associated factors among obstetric admissions to the high dependence unit at Kawempe Hospital

Abstract

Introduction: Obstetric emergencies are the leading cause of high maternal mortality in Uganda, yet access to critical care is still a challenge. Critical care is required for every one out of 14 deliveries. Reducing maternal mortality requires the integration of emergency and critical care services into obstetric care for the timely identification and management of obstetric emergencies. This study provides a better understanding of the maternal outcomes and associated factors of obstetric critical care admissions. Objective: To determine maternal outcomes and associated factors among obstetric admissions to the high-dependency unit at Kawempe National Referral Hospital (KNRH). Methods: This was a retrospective cohort study with internal comparison groups. It involved the extraction and review of obstetric patients' records (pregnant or within 42 days of termination of pregnancy) for three years, from January 2018 to December 2020. The study site was Kawempe National referral hospital (KNRH), the largest national referral women's hospital in the country located in Kampala metropolitan area. The study enrolled and followed up on patients' records up to 42 days of stay in HDU to determine maternal outcomes of obstetric admissions. Logistic regression was used to assess the association of independent variables with poor maternal outcomes. Ethical approval was obtained from the School of Medicine Research and Ethics Committee of Makerere University. Results: The median age (IQR) was 26 (22-31) years, with the majority of participants (56.4%) equally distributed between the ages of 20-24 and 25-29. The maternal outcomes recorded were discharges from HDU (86.0%), maternal mortality (8.0%), referral to another facility (4.2%) and transfer to ICU (1.8%). Patients who had complications while in HDU had 6.63 times increased odds of having poor maternal outcomes (adjusted OR = 6.63, 95% CI: 3.45-12.74, p-value = <0.001) when compared to those who did not have complications. Conclusion: There was 86% of discharge from HDU, which was a good outcome, and 14 % had poor maternal outcomes, which were mortality or referral to another facility for management of complications or more specialized care. Abnormal oxygen saturation at admission and complications while in HDU predisposed mothers to poor maternal outcomes. There was a paucity of vital sign recordings in the HDU