Determinants of maternal mortality among obstetric patients admitted to intensive care unit of Wolaita Sodo comprehensive specialized hospital, Southern Ethiopia: unmatched case-control study

Abstract

BACKGROUND: Maternal mortality among obstetric patients admitted to intensive care units (ICUs) remains disproportionately high in low-resource settings. Limited evidence exists regarding its determinants in such contexts. This study aimed to identify factors associated with maternal mortality among obstetric patients admitted to the ICU of Wolaita Sodo University Comprehensive Specialized Hospital, Southern Ethiopia. METHODS: An unmatched case–control study was conducted from November 23 to December 23, 2023, at Wolaita Sodo University Comprehensive Specialized Hospital, Southern Ethiopia. A total of 378 obstetric ICU admissions over a 10-year period were reviewed, including 126 maternal deaths (cases) and 252 survivors (controls), selected using simple random sampling. Data were extracted using a structured, pretested checklist. Bivariate analysis was used to identify candidate variables (p < 0.25) for inclusion in multivariable analysis where in statistical significance was established at p < 0.05. Strength of association was expressed by Adjusted odds ratios (AOR) with 95% confidence. RESULTS: Significant predictors of maternal mortality included ICU stay of fewer than five days [AOR = 2.61; 95% CI: 1.41–4.82], use of invasive mechanical ventilation [AOR = 3.82; 95% CI: 1.90–7.30], presence of shock [AOR = 6.80; 95% CI: 3.24–14.14], and multi-organ failure [AOR = 2.69; 95% CI: 1.03–6.98]. Mild [AOR = 0.19; 95% CI: 0.09–0.43] and moderate [AOR = 0.08; 95% CI: 0.04–0.18] reductions in the level of consciousness on admission were associated with lower odds of mortality compared to severe reduction. CONCLUSION AND RECOMMENDATIONS: Shorter ICU stay, invasive mechanical ventilation, development of shock, and multi-organ failure were independently associated with increased maternal mortality. Improved ICU triage protocols, early identification of complications, and appropriate critical care interventions are essential to improve maternal outcomes.