Time to maternal death and its predictors among obstetric ICU patients in a resource-limited setting: A 10-year survival analysis

Background: Maternal mortality remains a major concern in resource-limited settings, particularly among critically ill obstetric patients requiring intensive care unit (ICU) admission. Objective: 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. Methods: 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. Results: 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