Analysis of Maternal Deaths in the Obstetric Intensive Care Unit at the University Hospital for Mother and Child in N’Djamena

Objective: To contribute to a better understanding of the causes of maternal deaths in our setting and to describe the characteristics of the women who died.

Patients and Methods: The study was conducted in the Obstetric Intensive Care Unit at the University Hospital for Mother and Child in N’Djamena. This was a prospective, descriptive study conducted over a 12- month period, from June 2025 to June 2026. The study included all women admitted to the Intensive Care Unit who died from an obstetric complication that occurred during pregnancy, during childbirth, or within 42 days postpartum. Data were entered and analyzed using Excel 2016 and EpiInfo version 7.2.5.0.

Results: The incidence of maternal mortality that we calculated in the Department of Anesthesia and Intensive Care at the University Hospital for Mother and Child was 673.2 deaths per 100,000 live births. The mean age of the patients in our series was 26.08 (+/- 6.20) years, ranging from 14 to 41 years. Regarding the mode of admission, 62.5% (n=65) of the deaths were referred from various healthcare facilities across the country. In our series, 86 of the patients who died had not attended any prenatal care visits. It should be noted that of the 104 women who died in childbirth, 28.9% (n = 38) had given birth vaginally, while 51.9% (n = 54) had undergone a cesarean section and 11.5% (n=12) had died during their pregnancies. With regard to maternal mortality by etiology, we classified the causes of death into two groups: deaths due to direct obstetric causes and deaths due to indirect obstetric causes. Direct obstetric causes were the most common, with 90 cases, accounting for 86.5% of total mortality. Hypertension and its complications ranked first in our study, accounting for 52 deaths, or 50% of all deaths. These were dominated by preeclampsia and eclampsia and were often complicated by associated organ damage (HELLP syndrome: 8 cases; acute kidney injury: 15 cases; pulmonary arterial hypertension: 8 cases; hemorrhagic stroke: 5 cases). Sepsis ranked second, with 21 deaths, accounting for 20.2%. Postpartum hemorrhage accounted for 13.5% of deaths, ranking third in terms of frequency. In our series, 56% (n=58) of the deaths occurred within 24 hours of hospitalization; some women even died within hours or even minutes of admission.

Conclusion: Maternal mortality is a family and social tragedy and a shock to the medical team. Our study confirms a predominance of conditions related to hypertension and sepsis. Deaths occur primarily among young women, often homemakers living in rural areas, highlighting the socioeconomic vulnerability of this population.

Keywords: Maternal Mortality, Resuscitation, Mother and Child University Hospital, N’Djamena, Chad.