Obstetric HDU: A Supply-Based Alternative for ICU Care in a Low-Income Setting: A Descriptive Study

Abstract

Abstract

Background: The demand of ICU care for obstetric patients is rising in low-income settings, where there is low ICU-bed capacity. Introduction of obstetric High-dependency unit (HDU) has been described as an effective strategy to bridge this gap in resource-restricted settings.

Objective: To describe the clinical characteristic and maternal outcomes of obstetric patients admitted to the first obstetric HDU in Ethiopia.

Study Design:  This was a descriptive study on clinical characteristics and maternal outcomes of obstetric patients admitted to obstetric HDU over one year (October 2021 to September 2022) at St. Paul’s Hospital Millennium Medical College (Ethiopia). Data were collected retrospectively through reviewing patients’ medical records using a data extraction format with KOBO collect tool. Data were analyzed using SPSS version 23 and simple descriptive statistics were employed. Proportions and percentages were used to present the results.

Results:  After excluding 18 patients who did not meet the inclusion criteria, a total of 355 obstetric patients who were admitted to an obstetric HDU were included in the final analysis.  Among these all-obstetric patients admitted to obstetric HDU, pre-eclampsia/ eclampsia (82/355, 23.1%) and postpartum hemorrhage (66/355, 18.6%) were the most frequent reasons for admission to the HDU whereas cardiac disease constituted 14.1% (50/355) of the indication for admissions to the unit.

Majority (318/355, 89.6%) from the study participants were transferred to other wards with improvement, while 37(7.9%) deteriorated with 9(2.53%) of them died. Septic shock (6/9, 66.6%) and DIC (2/9, 22.2%) were the leading causes of death in the HDU.

Conclusion:  Findings of our study demonstrate that opening HDU in a low-income setting is feasible and results in favorable maternal outcomes. Introduction of obstetric HDU in low-income settings is an effective intervention to reduce severe maternal morbidity and mortality associated with low ICU-bed capacity in those settings.