Prevalence, factors associated and outcomes of critical illness among high-risk postpartum mothers at a Ugandan tertiary hospital. A prospective observational study

Abstract

Background: Despite improving trends, there remains a high global burden of maternal mortality, which is almost invariably preceded by some form of critical illness. Timely recognition and appropriate intervention may prevent significant morbidity and mortality associated with critical illness. However, while this burden is most significant in low and middle-income countries, there is limited understanding of the burden of critical illness and efforts for early identification. We set out to determine the prevalence, associated factors and outcomes of critical illness among postpartum mothers using the Modified Early Obstetric Warning Score (MEOWS) at Kawempe National Referral Hospital (KNRH). Methods: We prospectively collected data from 512 high-risk postnatal ward patients at KNRH, a public tertiary hospital in Uganda, from October to December 2022 to identify reasons for admission, demographic and clinical characteristics, and outcomes following systematic sampling and monitored using the MEOWS at enrolment and then after 48 hours if still in the hospital. Critical illness was defined as having either two yellow triggers or one red trigger. Outcomes included hospital discharge, High dependency or Intensive Care Admission, or death or status at 28 days if still in hospital, whichever came first. Multivariate analysis was done to determine the factors associated with critical illness. Descriptive analysis is presented as proportions, frequencies and tables. Results: Of 512 mothers, 350 (68.36%) had critical illness using the MEOWS during the study period. The statistically significant factors associated with critical illness found include preeclampsia (APR 1.21, 95% CI 1.07-1.36), maternal age of ≤19 years (APR 0.85, 95% 0.73-0.99) and preterm labour (APR 0.88, 95% CI 0.78-1.00). Six (1.17%) mothers were admitted to HDU, and two (0.39%) were admitted to ICU. The median length of hospital stay for mothers with critical illness was five days (2 - 36) and three days (2 - 34) for mothers without critical illness. There was no death reported at Day 28 of follow-up. Conclusion: This study demonstrated the high proportion of postpartum mothers needing urgent intervention and close monitoring to avert critical illness among those in the high-risk postnatal wards in a public national referral hospital.