Avoidable factors associated with pregnant and postpartum patients admitted to two intensive care units in South Africa
Background. Identification and prevention of any avoidable factor (AVF) associated with pregnancy may reduce critical illnesses and the
need for intensive care unit (ICU) admission.
Objectives. To determine AVFs that occurred prior to the admission of pregnant and postpartum patients to two ICUs in South Africa
(SA) and the resulting maternal outcomes.
Methods. The hospital records of all pregnant and postpartum patients in two public hospital ICUs in Pietermaritzburg, SA, between 1 July
2010 and 30 April 2011 were assessed to identify pre-ICU AVFs. Each patient was followed up until the 7th day after ICU discharge or until
hospital discharge (whichever came first), to observe maternal outcomes: survival, death or hypoxic ischaemic brain injury (HIBI).
Results. Of 84 patients assessed, 41 (48.8%) had ≥1 AVF. Patient-related, administrative and health-worker-related AVFs were
identified in 32.1% (27/84), 19.0% (16/84) and 7.1% (6/84) of patients, respectively. The most common patient-related AVF was the
commencement of antenatal care after 20 weeks’ gestation. Unavailability of ICU beds was the most common administrative AVF.
Iatrogenic pulmonary oedema associated with intravenous fluid resuscitation was the most frequent health-worker-related AVF. Of
women who had AVFs, 9 (22.0%) died, 2 (4.9%) had HIBI and 30 (73.2%) suurvived. The relative risk of death or HIBI among patients
with AVF/s was 1.2 (p=0.7).
Conclusions. The principal interventions that may prevent AVFs are ongoing community health promotion, strengthening of obstetric
skills training on fluid resuscitation and expansion of critical care services.
Nnabuike Chibuoke Ngene, Department of Obstetrics and Gynaecology, Edendale Hospital, Pietermaritzburg, and School of Clinical Medicine, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa
Jagidesa Moodley, Women’s Health and HIV Research Group, University of KwaZulu-Natal, South Africa
Richard P von Rahden, Department of Anaesthesia, Critical Care and Pain Management, Grey’s Hospital, Pietermaritzburg, and School of Clinical Medicine, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa
Fathima Paruk, Department of Critical Care, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa
Polycarpe N Makinga, Department of Obstetrics and Gynaecology, Northdale Hospital, Pietermaritzburg, and School of Clinical Medicine, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa
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Date published: 2016-09-08
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