Obstetric Early Warning Score for Prognostication of Critically Ill Obstetric Patient

Abstract

Introduction Obstetric early warning score (OEWS) has been used conventionally for early identification of deteriorating obstetric patients in the labor room and ward settings. This study was conducted to determine if this simple clinical score could be used for prognosticating a critically ill patient in the ICU setting instead of sequential organ failure assessment score (SOFA) and acute physiology and chronic health evaluation (APACHE II) score. Materials and Methods A cohort study was conducted at Obstetrics Critical Care Unit, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi. A total of 250 obstetric patients were recruited after informed consent. The OEWS, SOFA, and APACHE II scores were calculated within 24 hours of admission. The patients were followed to study the maternal outcome. Results The area under receiver operator characteristic (AUROC) curve of OEWS, SOFA, and APACHE II for prediction of maternal mortality was 0.894 (95% CI, 0.849–0.929), 0.924 (95% CI, 0.884–0.954), and 0.93 (95% CI, 0.891–0.958), respectively. The standardized mortality ratio (SMR) for OEWS, SOFA, and APACHE II was 66.3, 62.5, and 69.15%, respectively. Conclusion Obstetric early warning score is as effective as the conventional SOFA and APACHE II to prognosticate the obstetric patient. Since OEWS is based only on clinical criteria, it can be done immediately on admission and can help in early allocation of appropriate manpower and resources for optimum outcome. Clinical significance The clinical application of this study will help intensivists to prognosticate the critically ill obstetric patients immediately following admission to the critical care unit. How to cite this article Khergade M, Suri J, Bharti R, Pandey D, Bachani S, Mittal P. Obstetric Early Warning Score for Prognostication of Critically Ill Obstetric Patient. Indian J Crit Care Med 2020;24(6):398–403.

Clinical characteristics and outcomes of obstetric patients transferred directly to intensive care units

“…Additionally, previous research has indicated that the best predictor for outcomes for pregnant women with sepsis is SOFA score [ 15 ], and outcomes for patients with postpartum hemorrhage are strongly predicted by both the SOFA and APACHE II scores [ 16 ]. Findings from this study were in agreement with these results as higher SOFA and APACHE II scores upon admission at our institution’s ICU were significantly associated with either longer ICU length of stay or longer hospital length of stay.…”

Comparison of the efficacy for early warning systems in predicting obstetric critical illness

“…Reducing maternal mortality has always been an important topic of health care [5]. Many studies have suggested that early identi cation of critical pregnant women and early treatment of high-risk pregnant women through obstetric early warning system is an effective measure to prevent high-risk patients from progressing to the state of urgent rescue or death [19][20][21].…”

“…As is known, pregnancy is associated with many physiological changes involving cardiovascular, respiratory, renal and hematological system, and most of these changes can be re ected by the parameters of vital signs (HR, BP, RR, temperature, and mental status) [2][3][4]. Obstetric early warning systems are predictive models for early identi cation of women at risk, which rely on a phase of partial decompensation in physiology as a window of opportunity to intervene and prevent deterioration [5][6][7][8].…”

“…Seven parameters, including temperature, RR, oxygen absorption concentration of maintaining SPO2 ≥ 96%, HR, SBP and DBP were used. Several studies have been shown that ICNARC OEWS had good predictive ability for maternal death [5,13]. Until now, ICNARC OEWS is the most studied weighted score system.…”

Evaluating Effectiveness of MEOWS Tool in Identifying Maternal Deterioration in Women Receiving Care among Nurses in Maternity Unit, at General Hospital, Dammam

“…'MEOWS' is now extensively used in obstetric practice, but the systems in use vary significantly (Khergade et al, 2020). The physiological parameters commonly included in MEOWS are pulse rate, respiratory rate, systolic pressure, diastolic pressure, temperature, and urine output ml/hr (Table 1).…”