Published in PLOS One on 2026-06-30, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Tigist Nega Alemu, Wondimagegn Genaneh Shiferaw, Workneh Elias Orsongo, Solomon Medina Megule, Wondu Feyisa Balcha
Source: PLOS One • DOI 10.1371/journal.pone.0352904
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Maternal mortality remains a major concern in resource-limited settings, particularly among critically ill obstetric patients requiring intensive care unit (ICU) admission.
To assess the time to maternal death and identify its predictors among obstetric patients admitted to the intensive care unit (ICU) in a resource-limited tertiary hospital in southern Ethiopia, over a ten-year period.
A retrospective cohort study was conducted among 378 obstetric patients admitted to the ICU between 2014 and 2023. Kaplan-Meier analysis estimated survival probability, multivariable Cox proportional hazards regression identified independent predictors of time to maternal death reported as adjusted hazard ratios (AHR) with 95% confidence intervals, and a Fine-Gray competing-risks model was additionally conducted with discharge alive as the competing event.
Of 378 obstetric ICU admissions, 126 resulted in maternal death, with a median time to death of 2.71 days (95% CI: 2.13–3.44); 71.4% of deaths occurred within the first five days, and survival probability declined rapidly before stabilizing after ten days. Rural residency (AHR 1.56, 95% CI 1.03–2.37), shock (AHR 2.27, 95% CI 1.44–3.56), multi-organ failure (AHR 1.75, 95% CI 1.09–2.78), mechanical ventilation (AHR 1.82, 95% CI 1.11–2.98), and impaired consciousness (moderate GCS: AHR 2.94; severe GCS: AHR 5.43, both p < 0.001) were independently associated with higher hazard of death, with findings consistent across the Fine–Gray competing-risks model.
Maternal ICU deaths occurred early, with most fatalities within the first week of admission and survival probability declining sharply in the first ten days. Shock, multi-organ failure, invasive mechanical ventilation, impaired consciousness at admission, and rural residency were independent predictors of shortened time to maternal death. Interventions targeting these conditions must be initiated early and urgently, particularly within the critical first days of ICU admission, to improve survival in resource-limited settings.
1. Introduction
According to the World Health Organization (WHO), maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes [1]. Maternal near-miss and severe acute maternal morbidity have recently come to be recognized as indicators of the quality of obstetric treatment [2,3].
Obstetric patients with various medical and surgical emergencies are admitted to an intensive care unit (ICU), which also offers supportive treatment to patients experiencing obstetric problems [4,5]. Approximately 1–9 per 1,000 deliveries require admission to intensive care units (ICUs), with the majority of admission diagnoses being related to obstetric complications [6,7]. Complications such as postpartum hemorrhage, sepsis, eclampsia, and other life-threatening diseases that require sophisticated monitoring and therapeutic measures might receive specialized care in intensive care units [8].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider hospital systems desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Tigist Nega Alemu, Wondimagegn Genaneh Shiferaw, Workneh Elias Orsongo, Solomon Medina Megule, Wondu Feyisa Balcha. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
Explore connected evidence
- Evidence brief: Survival and factors associated with intensive care unit mortality among adults with impaired consciousness in Benin, a low-resource setting: A retrospective cohort study
- Evidence brief: Neonatal survival and mortality predictors among low-birth-weight neonates: A Retrospective cohort study from Suhul Hospital, northern Ethiopia
- Evidence brief: Survival status and predictors of mortality among preterm neonates admitted to the neonatal intensive care unit at public hospitals of Harari region and Dire Dawa administration, eastern Ethiopia: Retrospective cohort study 2025
