Abstract
ObjectiveTo estimate the impact of the use of Intensive Care Units (ICU) in maternal mortality.MethodsA secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health, a multicenter cross‐sectional study conducted in maternity hospitals in 29 countries. Women who had severe maternal outcome (maternal death or maternal near‐miss) and the availability and use of ICU beds were included. The women were categorized according to availability of ICU, and multivariate logistic regression analyses were performed to determine the risk of maternal death. To rate the severity of complications, the Maternal Severity Score (MSS) and the Maternal Severity Index (MSI) were used.ResultsOf 314 623 women observed, 24 396 had severe complications. Of those, 16 981 (69.6%) were in facilities with ICUs; 1573 women were admitted to ICUs (6.4% of women with maternal complications and 0.5% of total). There is a significant protective effect for maternal mortality for patients with more severe conditions using ICUs (odds ratio 0.16, 95% confidence interval 0.07–0.33).ConclusionThe use of ICU was associated with significantly reduced odds of maternal death in obstetric patients with severe clinical conditions. The availability and appropriate use of good‐quality ICUs are therefore crucial to reduce maternal mortality.
Highlights
When the Human Development Index (HDI) was included in Model 3, the results showed that while the HDI was sig‐ nificantly associated with maternal death, it did not change the associ‐ ation between admission to an Intensive Care Units (ICU) and maternal mortality (0.18, 95% confidence interval (CI) 0.08–0.41)
The present study demonstrated that admission to an ICU was inde‐ pendently associated with a significant reduction in the odds of maternal mortality in severely ill obstetric patients
When analyzing maternal mortality and admission to an ICU alone or within traditional variables associated with maternal mortality, there was no association between maternal death and admission to an ICU; when introducing the severity score in the model (MSS), the utilization of an ICU was associated with fewer maternal deaths
Summary
The reduction of maternal mortality is a global public health priority, because the majority of maternal deaths are avoidable, and because maternal mortality represents broader gender and social inequities across and within countries.[1,2,3] Substantial progress has been achieved in reducing maternal mortality, but high rates of mater‐ nal mortality persist in many countries.[4,5,6,7]. There is a need for studies to explore and understand the use of ICUs for obstetric complications, especially in low‐ and middle‐income countries where health resources are scarce and the costs of ICUs are high.[12] With increasing healthcare expen‐ ditures, it is necessary to show evidence of effectiveness to drive investment.[13] The aim of the present study was to evaluate the impact of the availability and use of ICUs in the reduction of maternal mor‐ tality among women with severe complications related to pregnancy and childbirth
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