Severe Obstetric Haemorrhage in a General Intensive Care Unit in Ghana: Outcomes and Predictors of Mortality

Background: Obstetric haemorrhage remains one of the leading causes of maternal mortality worldwide and continues to contribute substantially to severe maternal morbidity in low-resource settings. However, limited data exist on the outcomes of women requiring specialized critical care for severe obstetric haemorrhage in Ghana. This study aimed to describe the clinical characteristics, outcomes, and predictors of mortality among women admitted with severe obstetric haemorrhage to the main intensive care unit (ICU) of Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana. Methods: A retrospective cohort study was conducted among women admitted with severe obstetric haemorrhage to KATH’s main ICU. Data on demographic characteristics, clinical parameters, critical care interventions, and hospital outcomes were extracted from patient records. Women were categorized as survivors or non-survivors. Univariable and multivariable logistic regression analyses were performed to identify factors associated with ICU mortality. Results: Among 344 obstetric admissions to KATH’s main ICU, 79 women were admitted with severe obstetric haemorrhage and were included in the study. Postpartum haemorrhage was the most common haemorrhage subtype (32, 40.5%), followed by abruptio placentae (18, 22.8%) and uterine rupture (12, 15.2%). Overall, 44 women died during admission, resulting in an ICU mortality rate of 55.7%. Women who died had significantly lower admission Glasgow Coma Scale (GCS) scores, lower diastolic blood pressure, shorter hospital stays, and were more likely to require mechanical ventilation than survivors. In multivariable logistic regression analysis, admission GCS score was independently associated with mortality (adjusted odds ratio [aOR] = 0.78, 95% confidence interval [CI]: 0.66–0.89; p = 0.001). Mechanical ventilation and vasopressor support were not independently associated with mortality after adjustment. Conclusion: Severe obstetric haemorrhage was associated with a high mortality rate among women admitted to a general intensive care unit in Ghana. Postpartum haemorrhage was the most common haemorrhage subtype, and admission GCS score was an independent predictor of mortality. Early recognition of clinical deterioration, prompt referral, and timely access to specialized critical care services may help improve maternal outcomes among women with severe obstetric haemorrhage.