Obstetric Comorbidity Index—A Promising Tool to Predict Maternal Morbidity

Bolanthakodi, Chethana; Bhat, Murali Shankar; Huchchannavar, Raghavendra

doi:10.5005/jp-journals-10006-2101

Cited by 3 publications

(3 citation statements)

References 11 publications

(3 reference statements)

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“…[ 36 , 37 ] Increasing age at parity, obesity, chronic hypertension, diabetes, artificial fertility treatment, and multiple pregnancies are important risk factors, which can be assessed by useful tools such as California Maternal Quality Care Collaborative (CMQCC) risk-assessment tool and the obstetric co morbidity index (OB-CMI). [ 38 ] Pre-existing chronic illness, infections like human immunodeficiency virus and tuberculosis, access to healthcare, mental health and ethnicity influence maternal outcomes.…”

Section: Management Of Obstetric Comorbiditiesmentioning

confidence: 99%

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Recent advances in obstetric anaesthesia and critical care

et al. 2023

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Newer modalities in labour analgesia and anaesthesia for caesarean section including regional anaesthesia techniques and airway management are emerging constantly. Techniques such as point of care ultrasound, especially of the lungs and stomach and point of care tests of coagulation based on viscoelastometry are about to revolutionise perioperative obstetric care. This has improved the quality of care thereby ensuring good perioperative outcomes in the parturient with comorbidities. Critical care for obstetrics is an emerging field that requires a multidisciplinary approach with obstetricians, maternal-foetal medicine experts, intensivists, neonatologists, and anaesthesiologists working together with enhanced preparedness and uniform protocols. Newer techniques and concepts of understanding have thus been established in the traditional speciality of obstetric anaesthesia over the last decade. These have improved maternal safety and neonatal outcomes. This article touches upon some recent advances that have made a significant impact in the field of obstetric anaesthesia and critical care.

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Section: Management Of Obstetric Comorbiditiesmentioning

confidence: 99%

“…The OB-CMI is useful for prospectively quantifying the risk of severe maternal morbidity and need for ICU admission in antenatal parturients. [ 38 , 55 ]…”

Section: Critical Care In Obstetricsmentioning

confidence: 99%

Recent advances in obstetric anaesthesia and critical care

et al. 2023

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“…Severe maternal morbidity (SMM) is a more useful indicator than MMR for assessing the quality of obstetric care [5]. SMM is characterized by adverse outcomes of labor and labor processes that have significant short-or long-term consequences for women's health [6].…”

Section: Introductionmentioning

confidence: 99%

Association between Delivery during Off-Hours and the Risk of Severe Maternal Morbidity: A Nationwide Population-Based Cohort Study

Yun,

Park,

Nam

2023

JCM

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This study evaluated the association between off-hour deliveries and the risk of severe maternal morbidity (SMM). Data regarding Korean deliveries between 2005 and 2019 obtained from the National Health Insurance Service were used. SMM was evaluated using an algorithm developed by the United States Centers for Disease Control and Prevention. Modified Poisson regression analyses were conducted to investigate the association between off-hour deliveries and SMM, with stratification by hospital region and the number of beds. Approximately 32.7% of the 3,076,448 nulliparous women in this study delivered during off-hours, including 2.6% who experienced SMM. Patients who delivered at night had the highest risk of SMM (weekday nights, adjusted risk ratio (aRR): 1.41, 95% confidence interval (CI): 1.38–1.44; weekend nights, OR: 1.40, 95% CI: 1.34–1.46). The SMM of night deliveries was higher at hospitals located in small cities and those with 100–499 beds (weekend night: small cities, aRR: 1.49, 95% CI: 1.40–1.59; 100–499 beds, aRR: 1.83, 95% CI: 1.67–2.01; weekday night: small cities, aRR: 1.46, 95% CI: 1.42–1.51; 100–499 beds, aRR: 1.70, 95% CI: 1.62–1.79). Therefore, nighttime deliveries are associated with a higher risk of SMM, especially at hospitals located in small cities and those with 100–499 beds.

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Validation of a modified obstetric comorbidity index for prediction of postpartum adverse events including fetal morbidity - a retrospective cohort study from Qatar

Chaalan,

Minisha,

Zaidi

et al. 2024

BMC Pregnancy Childbirth

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Background The Obstetric Comorbidity Index (OBCMI) is an internationally validated scoring system for maternal risk factors intended to reliably predict the occurrence of severe maternal morbidity (SMM). This retrospective cohort study applied the OBCMI to pregnant women in Qatar to validate its performance in predicting SMM and cumulative fetal morbidity. Methods Data from 1000 women who delivered in July 2021 in a large tertiary centre was extracted from medical records. The OBCMI index included maternal demographics, pre-existing comorbidities, and various current pregnancy risk factors such as hypertension, including preeclampsia, intrauterine fetal death, prolonged rupture of membranes and unbooked pregnancies. SMM was based on the ACOG consensus definition, and the cumulative fetal morbidity (CFM) included fetal distress in labour, low APGAR and umbilical artery (UA) pH, admission to neonatal intensive care (NICU), and hypoxic-ischemic encephalopathy (HIE). A c-statistic or area under curve (AUC) was calculated to determine the ability of OBCMI to predict SMM and CFM. Results The median OBCMI score for the cohort was 1 (interquartile range- 0 to 2); 50% of women scored 0, while 85% (n = 842) had a score ranging from 0 to 2. Ten women (1%) scored ≥ 7; the highest score was 10. The incidence of SMM was 13%. According to the modified scoring system, the mean OBCMI score in those who developed SMM was 2.18 (± 2.20) compared to a mean of 1.04 (± 1.40) in those who did not (median 1, IQR:1–3 versus median 0, IQR: 0–2; p < 0.001). The incidence of CFM was 11.3%. The incidence of low APGAR score, HIE and NICU admission was nearly 1 in 1000. Around 5% of the babies had fetal distress in labour and low UA pH. For every 1 unit increase in OBCMI score, the odds of SMM increased by 44% (OR 1.44 95% CI 1.30–1.59; p < 0.001; AUC 0.66), and CFM increased by 28% (OR 1.28 95% CI 1.15–1.42; p < 0.001; AUC 0.61). A cut-off score of 4 had a high specificity (> 90%); 1 in 4 and 1 in 6 women with OBCMI score ≥ 4 developed SMM and CFM, respectively. Conclusion The OBCMI performed moderately well in predicting SMM in pregnant women of Qatar and can be effectively used as a risk assessment tool to red-flag high-risk cases so that appropriate and timely multidisciplinary care can be initiated to reduce SMM and maternal mortality. The index is also helpful in predicting fetal morbidity; however, further prospective studies are required to validate OBCMI for CFM.

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Obstetric Comorbidity Index—A Promising Tool to Predict Maternal Morbidity

Cited by 3 publications

References 11 publications

Recent advances in obstetric anaesthesia and critical care

Recent advances in obstetric anaesthesia and critical care

Association between Delivery during Off-Hours and the Risk of Severe Maternal Morbidity: A Nationwide Population-Based Cohort Study

Validation of a modified obstetric comorbidity index for prediction of postpartum adverse events including fetal morbidity - a retrospective cohort study from Qatar

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