Incidence and Causes of Maternal Morbidity and Mortality among Women Admitted to Intensive Care Unit

Abstract

Reduction of maternal death is a high priority for international community especially in view of increase attention on the millennium developmental goal. Maternal deaths arise from the risks of pregnancy and child birth as well as from poor quality care from health service. Effective services improve over all maternal health (WHO, 2013). Ideal care of this critically ill obstetric patient is provided by best especially trained obstetrician, trained obstetric nurse with extensive Knowledge and experience in critical care reduce maternal morbidity and mortality (Ayres, 2001). - Aim of study: The study was done to investigate Incidence and causes of maternal morbidity and mortality among women admitted to intensive care unit at Ain Shams University maternity Hospital. Subject and methods: - Setting: The study of a random sample was conducted at intensive care unit in Ain Shams University Maternity Hospital.

- Subject: Study sample consist of 100 women, all mother admitted to intensive care unit in the study setting during the time of study in Ain Sham University Maternity Hospital. Has a medical and obstetric problem. Tool for data collection:- Tools were used for data collections are A structured Interview questionnaire sheet (appendix I) it was designed by the researcher based on review of related literature. It was written in simple Arabic language. It consists of: Part 1: General characteristics of studied woman such as name, age, marital state, education, husband education and job. Part II: Medical history: This was for information about health, chronic disease and types, medications, as well as family history. It also includes exposures to hazards such as passive smoking and radiation. Part III: Obstetric history such as gravidity, parity, abortion, problem with previous pregnancy and labor, ANC, etc. Part IV: This was for information about the current pregnancy such as associated problems. ANC, etc. Part V: This part was intended to assess woman's exposure to physical and psychological stressors during pregnancy. The physical factors include question about rest, night sleep, naps, dietary regimen and accident. The psychological factor includes fear during pregnancy, far of labor, concern about baby as well as daily life and health problems. Part VI: This for the details of the ICU admission, indication, time and outcomes. Administrative design:- Approval to carryout this study will be obtained from director of Ain Shams University maternity Hospital. Field work: The researcher visited the intensive care unit three days/week during the time of study. Verbal approval of the pt. to participate was obtained before history taking and after explaining the purpose of study. The researcher obtain data from 2011 – 2012. Results of the present study revealed that: • The age of study sample was 20 – 45 years the majority of cases were house wife, living in urban area, low socioeconomic state and education. • Two fifth of women have chronic disease such as cardiac and hypertension. 40% of cases were hospitalized due to rheumatic heart disease. • Less than half of sample reported chronic disease in their families in the form of hypertension and diabetes. • More than tow fifth of woman taking medication as anticoagulant, for anemia, and non prescribed medication as for headache. • Almost three fourth of sample exposed to passive smoking majority at home and more than three fourth exposed to radiation. • Direct causes of ICU admission were heamorrhage (34%), preeclampsia (30%), hypertension (12%) and heart disease (10%). Slightly more than half of sample was admitted before labor and 6% of study sample was died. • About one third of sample was nulliparous and above quarter of sample was primigravida and nearly quarter of cases was had previous history of abortion. • Almost of cases have pregnancy problems such as hypertension, hemorrhage, preeclampsia, majority of cases was have ANC in first trimester due to health problems and 4 women had correct knowledge about time of first visit and number of visit. • One third of women expose to unfavorable physical factors and great majority were exposed to psychological stress factors. • Presence of relation between maternal mortality, mothers age, education, husband education and intake of non prescribes medication. It is evident that higher maternal mortality rate on older age group with no formal education either the woman of the husband and taking non prescribed medication. • There is higher relation between maternal mortality and those women not getting enough rest and exposed to unfavorable physical factors. • There are no statistically significance relations between maternal mortality and the indication or the time of ICU admission, obstetric history and family history.