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Erschienen in: The Journal of Obstetrics and Gynecology of India 6/2023

04.11.2023 | Original Article

Prediction of Maternal Morbidity and Mortality Risk Among Women with Medical Disorders Presenting to Emergency Obstetric care (EMOC): A Prospective Observational Study

verfasst von: Mecheril Balachandran Divya, Papa Dasari

Erschienen in: The Journal of Obstetrics and Gynecology of India | Ausgabe 6/2023

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Abstracts

Introduction

Medical disorders complicating pregnancy have recently emerged as the most common cause for maternal morbidity and mortality and it is important to predict mortality risk when they present in moribund state to emergency obstetric care so as to take and timely effective measures to prevent mortality.

Methods

This prospective observational study was conducted over 6 months among pregnant and post-partum women with medical disorders who sought emergency obstetric care at a tertiary care hospital. Severity of morbidity was assessed using SOFA and APACHE II scores at admission.

Results

Of the 128 women, 87.5% were pregnant, and 12.5% were post-partum. Hypertensive disorders, cardiac disorders, neurological disorders and infective disorders were 24.2%, 22.6%, 14% and 9.4%, respectively. The optimal cut-off SOFA score was 2 (AUC = 0.739) with 66% sensitivity and 71% specificity and APACHE II score cut-off was 6 (AUC = 0.732) with a sensitivity of 60% and specificity of 78% in predicting severe maternal morbidity. The median scores of APACHE II and SOFA are 14 and 4, respectively, for non-survivors and for survivors it was 4 and 1.

Conclusion

Hypertensive disorder was the most common medical disorder, but severity was high in cardiac disorder. SOFA and APACHE II scores are good predictors of morbidity and mortality risk.
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Literatur
1.
Zurück zum Zitat Narayan B, Nelson-Piercy C. Medical problems in pregnancy. Clin Med. 2017;17(3):251.CrossRef Narayan B, Nelson-Piercy C. Medical problems in pregnancy. Clin Med. 2017;17(3):251.CrossRef
2.
Zurück zum Zitat Mantel GD, Buchmann E, Rees H, et al. Severe acute maternal morbidity: a pilot study of a definition for a near-miss. BJOG Int J Obstet Gynaecol. 1998;105(9):985–90.CrossRef Mantel GD, Buchmann E, Rees H, et al. Severe acute maternal morbidity: a pilot study of a definition for a near-miss. BJOG Int J Obstet Gynaecol. 1998;105(9):985–90.CrossRef
3.
Zurück zum Zitat Ferreira FL, Bota DP, Bross A, et al. Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA. 2001;286(14):1754–8.CrossRefPubMed Ferreira FL, Bota DP, Bross A, et al. Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA. 2001;286(14):1754–8.CrossRefPubMed
4.
Zurück zum Zitat Knaus WA, Draper EA, Wagner DP, et al. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13(10):818–29.CrossRefPubMed Knaus WA, Draper EA, Wagner DP, et al. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13(10):818–29.CrossRefPubMed
5.
Zurück zum Zitat Demirkiran O, Dikmen Y, Utku T, et al. Critically ill obstetric patients in the intensive care unit. Int J Obstet Anesth. 2003;12(4):266–70.CrossRefPubMed Demirkiran O, Dikmen Y, Utku T, et al. Critically ill obstetric patients in the intensive care unit. Int J Obstet Anesth. 2003;12(4):266–70.CrossRefPubMed
6.
Zurück zum Zitat Keizer JL, Zwart JJ, Meerman RH, et al. Obstetric intensive care admissions: a 12-year review in a tertiary care centre. Europ J Obstet Gynecol Reprod Biol. 2006;128(1–2):152–6.CrossRef Keizer JL, Zwart JJ, Meerman RH, et al. Obstetric intensive care admissions: a 12-year review in a tertiary care centre. Europ J Obstet Gynecol Reprod Biol. 2006;128(1–2):152–6.CrossRef
7.
Zurück zum Zitat Vargas M, Marra A, Buonanno P, et al. Obstetric admissions in ICU in a tertiary care center: a 5-years retrospective study. Indian J Crit Care Med Peer-Rev. 2019;23(5):213.CrossRef Vargas M, Marra A, Buonanno P, et al. Obstetric admissions in ICU in a tertiary care center: a 5-years retrospective study. Indian J Crit Care Med Peer-Rev. 2019;23(5):213.CrossRef
8.
Zurück zum Zitat Pattinson RC, Buchmann E, Mantel G, et al. Can enquiries into severe acute maternal morbidity act as a surrogate for maternal death enquiries? BJOG Int J Obstet Gynaecol. 2003;110(10):889–93.CrossRef Pattinson RC, Buchmann E, Mantel G, et al. Can enquiries into severe acute maternal morbidity act as a surrogate for maternal death enquiries? BJOG Int J Obstet Gynaecol. 2003;110(10):889–93.CrossRef
9.
Zurück zum Zitat Parmar NT, Parmar AG, Mazumdar VS. Incidence of maternal “near-miss” events in a tertiary care hospital of central Gujarat, India. J Obstet Gynecol India. 2016;66(1):315–20.CrossRef Parmar NT, Parmar AG, Mazumdar VS. Incidence of maternal “near-miss” events in a tertiary care hospital of central Gujarat, India. J Obstet Gynecol India. 2016;66(1):315–20.CrossRef
10.
Zurück zum Zitat Kumar R, Gupta A, Suri T, et al. Determinants of maternal mortality in a critical care unit: a prospective analysis. Lung India. 2022;39(1):44–50.CrossRefPubMed Kumar R, Gupta A, Suri T, et al. Determinants of maternal mortality in a critical care unit: a prospective analysis. Lung India. 2022;39(1):44–50.CrossRefPubMed
11.
Zurück zum Zitat Sodhi K, Bansal V, Shrivastava A, et al. Predictors of mortality in critically ill obstetric patients in a tertiary care intensive care unit: a prospective 18 months study. J Obstet Anaesth Crit Care. 2018;8(2):73.CrossRef Sodhi K, Bansal V, Shrivastava A, et al. Predictors of mortality in critically ill obstetric patients in a tertiary care intensive care unit: a prospective 18 months study. J Obstet Anaesth Crit Care. 2018;8(2):73.CrossRef
12.
Zurück zum Zitat Fadiloglu E, Yuksel ND, Unal C, et al. Characteristics of obstetric admissions to intensive care unit: APACHE II, SOFA and the Glasgow coma scale. J Perinat Med. 2019;47(9):947–57.CrossRefPubMed Fadiloglu E, Yuksel ND, Unal C, et al. Characteristics of obstetric admissions to intensive care unit: APACHE II, SOFA and the Glasgow coma scale. J Perinat Med. 2019;47(9):947–57.CrossRefPubMed
13.
Zurück zum Zitat Khergade M, Suri J, Bharti R, et al. Obstetric early warning score for prognostication of critically ill obstetric patient. Indian J Crit Care Med Peer-Rev. 2020;24(6):398.CrossRef Khergade M, Suri J, Bharti R, et al. Obstetric early warning score for prognostication of critically ill obstetric patient. Indian J Crit Care Med Peer-Rev. 2020;24(6):398.CrossRef
14.
Zurück zum Zitat Escobar MF, Nasner D, Hurtado CF, et al. Characterization of obstetric patients with sepsis identified by two diagnostic scales at a fourth-level clinic in Colombia. Int J Gynecol Obstet. 2018;143(1):71–6.CrossRef Escobar MF, Nasner D, Hurtado CF, et al. Characterization of obstetric patients with sepsis identified by two diagnostic scales at a fourth-level clinic in Colombia. Int J Gynecol Obstet. 2018;143(1):71–6.CrossRef
15.
Zurück zum Zitat Oliveira-Neto AF, Parpinelli MA, Costa ML, et al. Prediction of severe maternal outcome among pregnant and puerperal women in obstetric ICU. Crit Care Med. 2019;47(2):e136-43.CrossRefPubMed Oliveira-Neto AF, Parpinelli MA, Costa ML, et al. Prediction of severe maternal outcome among pregnant and puerperal women in obstetric ICU. Crit Care Med. 2019;47(2):e136-43.CrossRefPubMed
16.
Zurück zum Zitat Oliveira-Neto A, Parpinelli MA, Cecatti JG, et al. Sequential organ failure assessment score for evaluating organ failure and outcome of severe maternal morbidity in obstetric intensive care. Sci World J. 2012;1:2012. Oliveira-Neto A, Parpinelli MA, Cecatti JG, et al. Sequential organ failure assessment score for evaluating organ failure and outcome of severe maternal morbidity in obstetric intensive care. Sci World J. 2012;1:2012.
17.
Zurück zum Zitat Roopa P, Verma S, Rai L, et al. “Nearmiss” obstetric events and maternal deaths in a tertiary care hospital: an audit. J Pregnancy. 2013;2013:393758 Roopa P, Verma S, Rai L, et al. “Nearmiss” obstetric events and maternal deaths in a tertiary care hospital: an audit. J Pregnancy. 2013;2013:393758
18.
Zurück zum Zitat Norhayati MN, Hazlina NH, Sulaiman Z, et al. Severe maternal morbidity and near misses in tertiary hospitals, Kelantan, Malaysia: a cross-sectional study. BMC Public Health. 2016;16(1):1–3.CrossRef Norhayati MN, Hazlina NH, Sulaiman Z, et al. Severe maternal morbidity and near misses in tertiary hospitals, Kelantan, Malaysia: a cross-sectional study. BMC Public Health. 2016;16(1):1–3.CrossRef
19.
Zurück zum Zitat Binda J, Solanki G. Clinical and etiological study of maternal near-miss at a tertiary referral hospital of central India. Indian J Obstet Gynaecol Res. 2016;3(1):28–31.CrossRef Binda J, Solanki G. Clinical and etiological study of maternal near-miss at a tertiary referral hospital of central India. Indian J Obstet Gynaecol Res. 2016;3(1):28–31.CrossRef
20.
Zurück zum Zitat Siddiqui SA, Soomro N, Hasnain FS. Severe obstetric morbidity and its outcome in patients presenting in a tertiary care hospital of Karachi. JPMA J Pak Med Assoc. 2012;62(3):226.PubMed Siddiqui SA, Soomro N, Hasnain FS. Severe obstetric morbidity and its outcome in patients presenting in a tertiary care hospital of Karachi. JPMA J Pak Med Assoc. 2012;62(3):226.PubMed
21.
Zurück zum Zitat Bhadade R, de Souza R, More A, et al. Maternal outcomes in critically ill obstetrics patients: a unique challenge. Indian J Crit Care Med Peer-Reviewed Off Publ Indian Soc Crit Care Med. 2012;16(1):8. Bhadade R, de Souza R, More A, et al. Maternal outcomes in critically ill obstetrics patients: a unique challenge. Indian J Crit Care Med Peer-Reviewed Off Publ Indian Soc Crit Care Med. 2012;16(1):8.
22.
Zurück zum Zitat Jain S, Guleria K, Vaid NB, et al. Predictors and outcome of obstetric admissions to intensive care unit: a comparative study. Indian J Public Health. 2016;60(2):15914.CrossRef Jain S, Guleria K, Vaid NB, et al. Predictors and outcome of obstetric admissions to intensive care unit: a comparative study. Indian J Public Health. 2016;60(2):15914.CrossRef
23.
Zurück zum Zitat Kamal S, Singh V, Singh S. A study of clinical characteristics and outcome of obstetric patients in intensive care and high dependency unit of a tertiary centre of Jharkhand, India. Int J Reprod Contracept Obstet Gynecol. 2020;9:394–9.CrossRef Kamal S, Singh V, Singh S. A study of clinical characteristics and outcome of obstetric patients in intensive care and high dependency unit of a tertiary centre of Jharkhand, India. Int J Reprod Contracept Obstet Gynecol. 2020;9:394–9.CrossRef
Metadaten
Titel
Prediction of Maternal Morbidity and Mortality Risk Among Women with Medical Disorders Presenting to Emergency Obstetric care (EMOC): A Prospective Observational Study
verfasst von
Mecheril Balachandran Divya
Papa Dasari
Publikationsdatum
04.11.2023
Verlag
Springer India
Erschienen in
The Journal of Obstetrics and Gynecology of India / Ausgabe 6/2023
Print ISSN: 0971-9202
Elektronische ISSN: 0975-6434
DOI
https://doi.org/10.1007/s13224-023-01859-4

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