Patterns, Indications and Clinical Outcomes of Obstetric Intensive Care Unit Admissions: A Comprehensive Review

Abstract

Background: Obstetric admission to the intensive care unit (ICU) is a major indicator of severe maternal morbidity and reflects the capacity of healthcare systems to manage life-threatening pregnancy-related complications. Despite advances in maternal healthcare, obstetric ICU admissions remain associated with high maternal and neonatal morbidity and mortality, particularly in low- and middle-income countries (LMICs). Objective: This review synthesizes current evidence on the patterns, indications, maternal and neonatal outcomes, and healthcare system factors associated with obstetric ICU admissions, with emphasis on resource-limited settings and Nigeria. Methods: A comprehensive review of the literature published between 2010 and 2025 was conducted using PubMed, Scopus, Web of Science, Google Scholar, and African Journals Online (AJOL). Eligible peer-reviewed studies reporting obstetric ICU admissions, their indications, and maternal or neonatal outcomes were reviewed. Findings were synthesized thematically. Results: Hypertensive disorders of pregnancy, obstetric haemorrhage, and maternal sepsis were consistently identified as the leading indications for obstetric ICU admission. Admission rates and maternal mortality were markedly higher in LMICs than in high-income countries, reflecting disparities in antenatal care, emergency obstetric services, referral systems, critical care infrastructure, and access to essential resources. Maternal critical illness was also associated with adverse neonatal outcomes, including preterm birth, low birth weight, increased neonatal intensive care unit admission, and higher perinatal mortality. Delayed referral, limited ICU capacity, shortages of skilled personnel, and financial barriers were major contributors to poor outcomes. Conclusion: Obstetric ICU admissions remain an important marker of maternal healthcare quality. Strengthening emergency obstetric care, referral systems, critical care services, and healthcare financing is essential to improve maternal and neonatal outcomes, particularly in resource-constrained settings