{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T03:37:09Z","timestamp":1793417829070,"version":"4.5.0"},"reference-count":45,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2021,12,31]],"date-time":"2021-12-31T00:00:00Z","timestamp":1640908800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"\n Introduction<\/jats:title>\n Obstetric intensive care unit admission (ICU) suggests severe morbidity. However, there is no available data on the subject in Ghana. This retrospective review was conducted to determine the indications for obstetric ICU admission, their outcomes and factors influencing these outcomes to aid continuous quality improvement in obstetric care.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n This was a retrospective review conducted in a tertiary hospital in Ghana. Data on participant characteristics including age and whether participant was intubated were collected from patient records for all obstetric ICU admissions from 1\n st<\/jats:sup>\n January 2010 to 31\n st<\/jats:sup>\n December 2019. Descriptive statistics were presented as frequencies, proportions and charts. Hazard ratios were generated for relations between obstetric ICU admission outcome and participant characteristics. A p-value <0.05 was deemed statistically significant.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n There were 443 obstetric ICU admissions over the review period making up 25.7% of all ICU admissions. The commonest indications for obstetric ICU admissions were hypertensive disorders of pregnancy (70.4%, n = 312\/443), hemorrhage (14.4%, n = 64\/443) and sepsis (9.3%, n = 41\/443). The case fatality rates for hypertension, hemorrhage, and sepsis were 17.6%, 37.5%, and 63.4% respectively. The obstetric ICU mortality rate was 26% (115\/443) over the review period. Age \u226525 years and a need for mechanical ventilation carried increased mortality risks following ICU admission while surgery in the index pregnancy was associated with a reduced risk of death.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Hypertension, haemorrhage and sepsis are the leading indications for obstetric ICU admissions. Thus, preeclampsia screening and prevention, as well as intensifying antenatal education on the danger signs of pregnancy can minimize obstetric complications. The establishment of an obstetric HDU in CCTH and the strengthening of communication between specialists and the healthcare providers in the lower facilities, are also essential for improved pregnancy outcomes. Further studies are needed to better appreciate the wider issues underlying obstetric ICU admission outcomes.<\/jats:p>\n <\/jats:sec>\n \n Plain language summary<\/jats:title>\n This was a review of the reasons for admitting severely-ill pregnant women and women who had delivered within the past 42 days to the intensive care unit (ICU), the admission outcomes and risk factors associated with ICU mortality in a tertiary hospital in a low-resource country. High blood pressure and its complications, bleeding and severe infections were observed as the three most significant reasons for ICU admissions in decreasing order of significance. Pre-existing medical conditions and those arising as a result of, or aggravated by pregnancy; obstructed labour and post-operative monitoring were the other reasons for ICU admission over the study period. Overall, 26% of the admitted patients died at the ICU and maternal age of at least 25 years and the need for intubation were identified as risk factors for ICU deaths. Attention must be paid to high blood pressure during pregnancy.<\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0261974","type":"journal-article","created":{"date-parts":[[2021,12,31]],"date-time":"2021-12-31T13:36:38Z","timestamp":1640957798000},"page":"e0261974","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":8,"title":["A ten-year review of indications and outcomes of obstetric admissions to an intensive care unit in a low-resource country"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3020-2159","authenticated-orcid":true,"given":"Betty","family":"Anane-Fenin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evans Kofi","family":"Agbeno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Osarfo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2321-387X","authenticated-orcid":true,"given":"Douglas Aninng","family":"Opoku Anning","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abigail Serwaa","family":"Boateng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8293-6862","authenticated-orcid":true,"given":"Sebastian","family":"Ken-Amoah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony Ofori","family":"Amanfo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonard","family":"Derkyi-Kwarteng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Mouhajer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah Ama","family":"Amoo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joycelyn","family":"Ashong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ernestina","family":"Jeffery","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,12,31]]},"reference":[{"key":"pone.0261974.ref001","doi-asserted-by":"crossref","first-page":"1465","DOI":"10.1007\/s00134-010-1951-0","article-title":"Pregnant and postpartum admissions to the intensive care unit: a systematic review.","volume":"36","author":"W Pollock","year":"2010","journal-title":"Intensive Care Med"},{"key":"pone.0261974.ref002","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.ijoa.2019.03.004","article-title":"Obstetric admissions and outcomes in an intensive care unit in Malawi.","volume":"39","author":"M Prin","year":"2019","journal-title":"Int J Obstet Anesth"},{"key":"pone.0261974.ref003","volume-title":"Maternal deaths decline slowly with vast inequalities worldwide","author":"World Health Organization (WHO)","year":"2019"},{"key":"pone.0261974.ref004","unstructured":"WHO. Evaluating the quality of care for severe pregnancy complications The WHO near-miss approach for maternal health. 2012."},{"key":"pone.0261974.ref005","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1186\/s12884-017-1370-0","article-title":"Validating the WHO maternal near miss tool: comparing high- and low-resource settings.","volume":"17","author":"T Witteveen","year":"2017","journal-title":"BMC Pregnancy Childbirth"},{"key":"pone.0261974.ref006","doi-asserted-by":"crossref","first-page":"8","DOI":"10.7196\/SAJCC.164","article-title":"Obstetric intensive care admissions at a tertiary hospital in Limpopo Province, South Africa.","volume":"31","author":"TS Ntuli","year":"2015","journal-title":"South African J Crit Care"},{"key":"pone.0261974.ref007","doi-asserted-by":"crossref","first-page":"e0116949","DOI":"10.1371\/journal.pone.0116949","article-title":"Intensive Care Unit Capacity in Low-Income Countries: A Systematic Review.","volume":"10","author":"S Murthy","year":"2015","journal-title":"PLoS One"},{"key":"pone.0261974.ref008","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.jcrc.2020.10.009","article-title":"Capacity of intensive care units in Ghana.","volume":"61","author":"M Siaw-Frimpong","year":"2021","journal-title":"J Crit Care"},{"key":"pone.0261974.ref009","first-page":"12","article-title":"Obstetric patients admitted to the intensive care unit of Dr George Mukhari Academic Hospital, Ga-Rankuwa, South Africa.","volume":"33","author":"M. Motiang","year":"2017","journal-title":"South African J Crit Care"},{"key":"pone.0261974.ref010","article-title":"(PDF) CRITICAL CARE OF THE OBSTETRIC PATIENTS IN THE INTENSIVE CARE UNIT OF A NIGERIAN TERTIARY HOSPITAL -A 4 YEAR REVIEW","volume":"1","author":"J. Abiodun","year":"2015","journal-title":"Glob Scholast Res J Multidiscip"},{"issue":"12","key":"pone.0261974.ref011","doi-asserted-by":"crossref","first-page":"1558","DOI":"10.1111\/1471-0528.16285","article-title":"Obstetric admissions to intensive care units in Australia and New Zealand: a registry-based cohort study.","volume":"127","author":"MJ Maiden","year":"2020","journal-title":"BJOG"},{"key":"pone.0261974.ref012","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1007\/s00134-009-1707-x","article-title":"Obstetric intensive care unit admission: A 2-year nationwide population-based cohort study.","volume":"36","author":"JJ Zwart","year":"2010","journal-title":"Intensive Care Med"},{"key":"pone.0261974.ref013","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1111\/j.1479-828X.2011.01303.x","article-title":"Obstetric admissions to an integrated general intensive care unit in a quaternary maternity facility.","volume":"51","author":"TM Crozier","year":"2011","journal-title":"Aust New Zeal J Obstet Gynaecol"},{"key":"pone.0261974.ref014","doi-asserted-by":"crossref","first-page":"209","DOI":"10.5468\/ogs.2018.61.2.209","article-title":"Indications and characteristics of obstetric patients admitted to the intensive care unit: A 22-year review in a tertiary care center.","volume":"61","author":"HY Yi","year":"2018","journal-title":"Obstet Gynecol Sci"},{"key":"pone.0261974.ref015","doi-asserted-by":"crossref","first-page":"2909","DOI":"10.18203\/2320-1770.ijrcog20182905","article-title":"Study of outcome of obstetric emergencies admitted to intensive care unit.","volume":"7","author":"BR Bahadur","year":"2018","journal-title":"Int J Reprod Contraception, Obstet Gynecol"},{"key":"pone.0261974.ref016","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1016\/j.jcrc.2016.07.015","article-title":"What is an intensive care unit? A report of the task force of the World Federation of Societies of Intensive and Critical Care Medicine.","volume":"37","author":"JC Marshall","year":"2017","journal-title":"J Crit Care"},{"key":"pone.0261974.ref017","doi-asserted-by":"crossref","first-page":"S51","DOI":"10.1016\/j.accpm.2016.06.005","article-title":"Intensive care and pregnancy: Epidemiology and general principles of management of obstetrics ICU patients during pregnancy","volume":"35","author":"L Zieleskiewicz","year":"2016","journal-title":"Anaesth Crit Care Pain Med"},{"key":"pone.0261974.ref018","first-page":"44","article-title":"Obstetric and gynaecological admissions in an intensive care unit of a Nigerian teaching hospital: a 5-year review.","volume":"33","author":"SM Adelaiye","year":"2016","journal-title":"Trop J Obstet Gynaecol"},{"key":"pone.0261974.ref019","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1016\/j.ijoa.2004.04.002","article-title":"Admission pattern and outcome in critical care obstetric patients.","volume":"13","author":"V. Okafor U","year":"2004","journal-title":"Int J Obstet Anesth"},{"key":"pone.0261974.ref020","first-page":"356","article-title":"Course and Outcome of Obstetric Patients Admitted to a University Hospital Intensive Care Unit","volume":"88","author":"F Githae","year":"2011","journal-title":"East Afr Med J"},{"key":"pone.0261974.ref021","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1080\/01443610600720188","article-title":"Obstetric patients in a surgical intensive care unit: Prognostic factors and outcome.","volume":"26","author":"K Mjahed","year":"2006","journal-title":"J Obstet Gynaecol (Lahore)"},{"key":"pone.0261974.ref022","doi-asserted-by":"crossref","first-page":"P513","DOI":"10.1186\/cc9933","article-title":"Clinical characteristics and outcomes of obstetric patients requiring ICU admission.","volume":"15","author":"H El-Abd","year":"2011","journal-title":"Crit Care"},{"key":"pone.0261974.ref023","doi-asserted-by":"crossref","first-page":"159","DOI":"10.4103\/0019-557X.184575","article-title":"Predictors and outcomes of obstetric admissions to intensive care unit. A comparative study","volume":"60","author":"S Jain","year":"2016","journal-title":"Indian Journal of Public Health"},{"key":"pone.0261974.ref024","first-page":"283","article-title":"Racial\/ethnic differences in pregnancy-related hypertensive disease in nulliparous women.","volume":"24","author":"G Ghosh","year":"2014","journal-title":"Ethn Dis"},{"key":"pone.0261974.ref025","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1038\/jhh.2009.45","article-title":"Maternal risk factors for hypertensive disorders in pregnancy: A multivariate approach.","volume":"24","author":"LCY Poon","year":"2010","journal-title":"J Hum Hypertens"},{"key":"pone.0261974.ref026","first-page":"55","article-title":"Relationship between Maternal Age and Preeclampsia.","volume":"15","author":"N Kumari","year":"2016","journal-title":"IOSR J Dent Med Sci"},{"issue":"2","key":"pone.0261974.ref027","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.ijgo.2013.05.017","article-title":"Maternal deaths attributable to hypertensive disorders in a tertiary hospital in Ghana.","volume":"123","author":"K Adu-Bonsaffoh","year":"2013","journal-title":"Int J Gynecol Obstet"},{"issue":"1","key":"pone.0261974.ref028","first-page":"56","article-title":"Maternal mortality at the Korle Bu Teaching Hospital, Accra, Ghana: A five year review","volume":"25","author":"TK Boafor","year":"2021","journal-title":"African Journal of Reproductive Health"},{"issue":"1","key":"pone.0261974.ref029","doi-asserted-by":"crossref","first-page":"103","DOI":"10.9734\/jammr\/2020\/v32i130357","article-title":"Magnitude, trends and causes of maternal mortality: A 7-year review at a tertiary hospital in River State, Nigeria.","volume":"32","author":"PA Awoyesuku","year":"2020","journal-title":"JAMMR"},{"key":"pone.0261974.ref030","article-title":"Perinatal outcomes of hypertensive disorders in pregnancy at a referral hospital, Southern Ethiopia.","volume":"14","author":"NA Asseffaid","year":"2019","journal-title":"PLoS One"},{"key":"pone.0261974.ref031","first-page":"51","volume-title":"Levels and Causes of Maternal Mortality and Morbidity. Dis. Control Priorities","author":"The World Bank","year":"2016","edition":"3"},{"key":"pone.0261974.ref032","first-page":"1","article-title":"Perinatal Outcome in Women with Hypertensive Disorders of Pregnancy: A Retrospective Cohort Study.","volume":"2015","author":"G Endeshaw","year":"2015","journal-title":"Int Sch Res Not"},{"key":"pone.0261974.ref033","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1053\/j.semperi.2009.02.010","article-title":"The Global Impact of Pre-eclampsia and Eclampsia.","volume":"33","author":"L. Duley","year":"2009","journal-title":"Semin Perinatol"},{"key":"pone.0261974.ref034","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/j.mjafi.2012.08.033","article-title":"Why do obstetric patients go to the ICU? A 3-year-study.","volume":"69","author":"S Chawla","year":"2013","journal-title":"Med J Armed Forces India"},{"key":"pone.0261974.ref035","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-021-03882-7","article-title":"High mortality rate of obstetric critically ill women in Rwanda and its predictability.","volume":"21","author":"A Rudakemwa","year":"2021","journal-title":"BMC Pregnancy and Childbirth"},{"issue":"1","key":"pone.0261974.ref036","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1186\/s12905-021-01396-0","article-title":"Women of reproductive age in a tertiary intensive care unit: indications, outcomes and the impact of pregnancy-a retrospective cohort study.","volume":"21","author":"KP Ramlakhan","year":"2021","journal-title":"BMC Women\u2019s Health"},{"issue":"1","key":"pone.0261974.ref037","doi-asserted-by":"crossref","first-page":"16","DOI":"10.4314\/mmj.v27i1.5","article-title":"Predictors of maternal mortality among critically ill obstetric patients.","volume":"27","author":"AS Adeniran","year":"2015","journal-title":"Malawi Med J"},{"key":"pone.0261974.ref038","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1016\/j.fertnstert.2015.03.004","article-title":"Reproduction at an advanced maternal age and maternal health","volume":"103","author":"V. Sauer M","year":"2015","journal-title":"Fertil Steril"},{"issue":"6","key":"pone.0261974.ref039","doi-asserted-by":"crossref","first-page":"1202","DOI":"10.1007\/s10995-014-1624-7","article-title":"Maternal age and risk of labour and delivery complications.","volume":"19","author":"PA Cavazos-Rehg","year":"2015","journal-title":"Maternal Child Health J"},{"key":"pone.0261974.ref040","unstructured":"WHO. Early marriages, adolescent and young pregnancies Report by the Secretariat. 2012."},{"key":"pone.0261974.ref041","first-page":"e919922","article-title":"Maternal characteristics and obstetric and neonatal outcomes of singleton pregnancies among adolescents","volume":"26","author":"EK Bas","year":"2020","journal-title":"Med Sci Monit"},{"key":"pone.0261974.ref042","doi-asserted-by":"crossref","first-page":"272","DOI":"10.3390\/healthcare9030272","article-title":"Linking Female Adolescents\u2019 Knowledge, Attitudes and Use of Contraceptives to Adolescent Pregnancy in Ghana: A Baseline Data for Developing Sexuality Education Programmes.","volume":"9","author":"BO Ahinkorah","year":"2021","journal-title":"Healthcare"},{"key":"pone.0261974.ref043","doi-asserted-by":"crossref","first-page":"73","DOI":"10.4103\/joacc.JOACC_57_17","article-title":"Predictors of mortality in critically ill obstetric patients in a tertiary care intensive unit. A prospective 18 months study.","volume":"8","author":"K Sodhi","year":"2018","journal-title":"J Obstet Anaesth Crit Care"},{"key":"pone.0261974.ref044","first-page":"154","article-title":"Ghana\u2019s neglected chronic disease epidemic: a developmental challenge.","volume":"41","author":"A. de-Graft Aikins","year":"2007","journal-title":"Ghana Med J"},{"issue":"2","key":"pone.0261974.ref045","first-page":"69","article-title":"A comprehensive review of the policy and programmatic response to chronic non-communicable disease in Ghana.","volume":"46","author":"W. Bosu","year":"2013","journal-title":"Ghana Med J"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0261974","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,31]],"date-time":"2021-12-31T13:37:21Z","timestamp":1640957841000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0261974"}},"subtitle":[],"editor":[{"given":"Orvalho","family":"Augusto","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,12,31]]},"references-count":45,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2021,12,31]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0261974","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,31]]}}}