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Provision of intensive care to severely ill pregnant women is associated with reduced mortality: Results from the WHO Multicountry Survey on Maternal and Newborn Health
Author(s) -
Soares Fabiano M.,
Pacagnella Rodolfo C.,
Tunçalp Özge,
Cecatti José G.,
Vogel Joshua P.,
Togoobaatar Ganchimeg,
Souza Joao P.
Publication year - 2020
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1002/ijgo.13241
Subject(s) - medicine , odds ratio , intensive care , logistic regression , confidence interval , maternal death , odds , pregnancy , cross sectional study , maternal morbidity , obstetrics , emergency medicine , pediatrics , intensive care medicine , population , environmental health , pathology , biology , genetics
Objective To estimate the impact of the use of Intensive Care Units (ICU) in maternal mortality. Methods A 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. Results Of 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). Conclusion The 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.