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Causes and risk factors of maternal mortality in the ICU

Introduction

Maternal mortality is considered a basic health indicator that reflects the adequacy of healthcare; in our country the overall maternal mortality is 69.8 per 100,000 live births (Tunisian National Enquiry into Maternal Deaths 1993–1994). In this study we tried to identify causes of maternal death in our ICU.

Methods

A prospective study of patients first managed in a tertiary referral maternity center for high-risk pregnancies. Collected data were age, gravity, parity, admission diagnosis and delivery mode. The APACHE II score, APACHE III score and SAPS Obst score were calculated. The study period was January 2004–December 2004. The outcome measure was mortality. We used the International Classification of Diseases definition of a maternal death: 'the death of a woman while pregnant or within 42 days of termination of pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes'.

Results

From 131 obstetrics admissions, 18 patients died (14%). Advanced age (33 ± 9), high gravity (2.8 ± 1.7) and high parity (2.77 ± 1.7) scores are common to all death. As compared with vaginal delivery (n = 9), caesarean delivery (n = 9) was not associated with a significantly increased risk for postpartum maternal death; the majority of maternal deaths are due to direct obstetric causes (16–89%). At admission all patients had high severity of illness scores, APACHE II (18.76 ± 16.65), APACHE III (71.58 ± 30.19) and SAPS Obst (30.29 ± 8.24), which indicates how grave our patients' health condition is. The most common cause of death was hypertensive disorders in five patients, infection in four patients and hemorrhage in three cases, other causes were pulmonary embolisms in two cases, one case of amniotic fluid embolism, one patient with peripartum cardiomyopathy, one patient with intracerebral hemorrhage and one patient with anaphylactic shock.

Conclusion

The knowledge of the specific causes involved in the maternal mortality risk could help to elaborate adequate preventive strategies to reduce maternal death.

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Kaddour, C., Souissi, R., Haddad, Z. et al. Causes and risk factors of maternal mortality in the ICU. Crit Care 12, P492 (2008). https://doi.org/10.1186/cc6713

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Keywords

  • Pulmonary Embolism
  • Caesarean Delivery
  • Maternal Mortality
  • Maternal Death
  • Hypertensive Disorder