Clinical Trials Logo

Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT04121234
Other study ID # 070919CUAMM
Secondary ID
Status Completed
Phase
First received
Last updated
Start date May 1, 2018
Est. completion date September 30, 2019

Study information

Verified date October 2019
Source Doctors with Africa - CUAMM
Contact n/a
Is FDA regulated No
Health authority
Study type Observational

Clinical Trial Summary

Sierra Leone faces the highest maternal mortality ratio in the world. Despite this extreme burden, the potential roles of obstetric critical care and high dependency units (HDUs) in this and other resource-limited settings remain scarcely explored. This study investigated epidemiology, clinical outcomes and risk factors for mortality in critically-ill parturients admitted to an obstetric HDU in a high volume, urban resource-limited maternity hospital.


Description:

This is a retrospective observational study in women admitted to the HDU of Princess Christian Maternity Hospital (PCMH), Freetown, Sierra Leone, from 2nd October 2017 to 2nd October 2018. The study received ethical approval and waiver of informed consent from the Sierra Leone Ethics and Scientific Review Committee (18/12/18).

A set of predefined variables was assessed at hospital admission, HDU admission and at discharge from HDU. The primary data source was the HDU patient chart, with data crosschecked with the hospital patient charts and the HDU admission book for quality control purpose. Data of hospital deliveries, admissions and mortality were form the hospital register and the maternal mortality hospital database. Data were retrospectively collected by a study physician (CM) and included: patient demographics; admission date and source; main reason for admission in hospital; main reason for admission to the HDU (classified as: haemodynamic instability; sepsis; haemorrhage; acute renal failure; neurological impairment; respiratory distress; severe malaria; coagulopathy; other diagnoses). These are clinical diagnoses included in the hospital checklist to facilitate communication of referral to HDU and are thus based on the clinical assessment of the attending physician rather than on a strict research definitions.

Vital signs and treatments collected at admission included body temperature, heart rate, respiratory rate, neurological status according to the AVPU scale, systolic and diastolic blood pressure, transcutaneous saturation (SpO2). The ratio between SpO2 and fraction of inspired oxygen (SpO2/FiO2) was also measured. The obstetric modified early warning score (OEWS) was also calculated.

Specific treatments received at any point during HDU stay were extracted from the patient file and included: oxygen supplementation, use of vasopressors, blood transfusions, antibiotic therapy, activation of the magnesium protocol for eclamptic seizures prevention and hypotensive treatment protocol with hydralazine. Point of care laboratory parameters such as capillary lactates levels and haemoglobin were collected when available. Time from PCMH admission to HDU admission was calculated. Length of stay and patient outcomes (classified as death in HDU, discharge to ward, or transfer to other facility) were reported at discharge.


Recruitment information / eligibility

Status Completed
Enrollment 523
Est. completion date September 30, 2019
Est. primary completion date June 30, 2019
Accepts healthy volunteers No
Gender Female
Age group N/A and older
Eligibility Inclusion Criteria:

- All women admitted at HDU of the PCMH from the 2nd October 2017 to the 2nd October 2018.

Exclusion Criteria:

- none

Study Design


Related Conditions & MeSH terms


Intervention

Other:
Exposure: " being admitted to HDU with a red code to OEWS"
High Dependency Unit, a set of predefined variables was assessed at hospital admission, HDU admission and at discharge from HDU with the aim to investigate epidemiology, clinical outcomes and risk factors for mortality in critically-ill parturients admitted to an obstetric HDU in a high volume, urban resource-limited maternity hospital

Locations

Country Name City State
Sierra Leone Princess Christian Maternity Hospital Freetown

Sponsors (1)

Lead Sponsor Collaborator
Doctors with Africa - CUAMM

Country where clinical trial is conducted

Sierra Leone, 

Outcome

Type Measure Description Time frame Safety issue
Primary Morality in HDU The primary endpoint was the association between modifiable and non-modifiable factors and mortality during HDU stay. HDU death was defined as death during HDU stay, i.e. from referral to HDU to discharge from HDU. one year
Secondary Hospital mortality Hospital mortality was death during the whole hospital stay. One year
Secondary Lenght of stay Time between the hdu admission and the hdu discharge, in days. One year
Secondary OEWS at the admission coded as: red, yellow, green one year
Secondary reasons of admission classified as: haemodynamic instability; sepsis; haemorrhage; acute renal failure; neurological impairment; respiratory distress; severe malaria; coagulopathy; other diagnoses One Year
Secondary Time of admission Night/day and Working days/weeknd One year
Secondary Treatments received oxygen supplementation (yes/no), use of vasopressors (yes/no), blood transfusions (yes/no), antibiotic therapy (yes/no), activation of the magnesium protocol for eclamptic seizures prevention (yes/no) and hypotensive treatment protocol with hydralazine during the stay (yes/no). One year
See also
  Status Clinical Trial Phase
Completed NCT03263182 - Impact of the Safe Childbirth Checklist in Luapula Province of Zambia Province of Zambia
Active, not recruiting NCT03871491 - Azithromycin-Prevention in Labor Use Study (A-PLUS) Phase 3
Recruiting NCT05382403 - Novel Vacuum-Induced Hemorrhage Control for Postpartum Hemorrhage N/A
Recruiting NCT04879797 - Reducing Racial Disparities in Severe Maternal Morbidity N/A
Completed NCT02318420 - The PartoMa Project: For Improving Monitoring, Action and Triage During Labour N/A
Completed NCT02148952 - BetterBirth: A Trial of the WHO Safe Childbirth Checklist Program N/A
Completed NCT03363308 - Effects of a Health Workforce Capacity Building and Quality Improvement Intervention in Kinshasa N/A
Recruiting NCT05015023 - Effectiveness of Health Education Provided to Couples on Utilization of Maternity Waiting Homes in Rural Ethiopia N/A
Recruiting NCT03929991 - Maternal Cesarian Section Infection (MACSI) in Sierra Leone
Recruiting NCT03220750 - University Hospital Advanced Age Pregnant Cohort N/A
Recruiting NCT06273007 - Improving Intrapartum Care for Saving Life at Birth in Ethiopia Through PartoMa Approach N/A
Active, not recruiting NCT03032276 - Safe Motherhood Promotion and Newborn Survival N/A
Not yet recruiting NCT06415942 - Assessing the Maternal Outcome Monitoring Systems N/A
Recruiting NCT04438798 - High Flow Nasal Cannula to Prevent Deoxygenation During Induction of General Anesthesia in Cesarean Section N/A
Recruiting NCT05678699 - The Effects of Medicaid Policy Interventions on Racial Equity in Severe Maternal Morbidity N/A
Recruiting NCT05865873 - Maternal Health Service Utilization Among Women of Reproductive Age in Sidama Region, Ethiopia N/A
Enrolling by invitation NCT05640050 - Integrated Community Engagement and Audit Systems N/A
Active, not recruiting NCT05430815 - Improving Women's Health Through Coordinated Postpartum Planning N/A
Terminated NCT04260386 - Assessing a New Proforma for Maternal Cardiac Arrest
Completed NCT02936869 - Incentives for Postnatal Care Demand N/A