Oxygen Saturation as a Predictor of Adverse Maternal Outcomes in Women with Preeclampsia

Abstract

Objective: We sought to determine the role of respiratory assessment by cardiorespiratory symptoms and/or oxygen saturation by pulse oximetry (SpO 2 ) in predicting adverse maternal outcomes in women admitted to hospital with preeclampsia .Methods: These data derive from an international, prospective multicentre cohort study, PIERS (Pre-eclampsia Integrated Estimate of RiSk), which assesses predictors of adverse outcomes in women admitted to tertiary perinatal units with preeclampsia . Univariate and multivariate analyses of cardiorespiratory symptoms and pulse oximetry were performed to assess their ability to predict a combined adverse maternal outcome developed through international Delphi consensus .Results: SpO 2 successfully predicted adverse maternal outcomes; the area under the receiver-operator characteristic curve (AUC ROC) was 0 .71 (95% CI 0 .65 to 0 .77) . Combining the symptoms of chest pain and/or dyspnea with pulse oximetry improved this predictive ability (AUC ROC 0 .73; 95% CI 0 .67 to 0 .78) . When SpO 2 was stratified into risk groups using inflection points on the ROC curve, the highest risk group (SpO 2 90% to 93%) had an odds ratio of 18 .1 (95% CI 8 .2 to 40 .2) for all outcomes within 48 hours when compared with the baseline group (SpO 2 98% to 100%) . Conclusion:Assessing SpO 2 aids in the assessment of maternal risk in women admitted to hospital with preeclampsia . An SpO 2 value of ≤ 93% confers particular risk . The symptom complex of chest pain and/or dyspnea adds to the association . RésuméObjectif : Nous avons cherché à déterminer le rôle de l'évaluation respiratoire en fonction des symptômes cardiorespiratoires et/ou celui de la détermination de la saturation en oxygène par oxymétrie pulsée (SaO 2 ) dans la prédiction des issues maternelles indésirables chez les femmes hospitalisées en raison d'une prééclampsie . Méthodes :Ces données sont issues de l'étude de cohorte multicentrique prospective internationale PIERS (Pre-eclampsia Integrated Estimate of RiSk), laquelle a évalué les facteurs prédictifs des issues indésirables chez les femmes admises dans des unités périnatales tertiaires en raison d'une prééclampsie . Des analyses univariées et multivariées des symptômes cardiorespiratoires et de l'oxymétrie pulsée ont été menées pour en évaluer la capacité de prédire une issue maternelle indésirable combinée, élaborée par consensus Delphi international .Résultats : La SaO 2 a permis de prédire avec succès les issues maternelles indésirables; la surface sous la courbe de la fonction d'efficacité de l'observateur-opérateur (AUC ROC) était de 0,71 (IC à 95 %, 0,65 -0,77) . Le fait de combiner les symptômes de la douleur thoracique et/ou de la dyspnée à l'oxymétrie pulsée a entraîné l'amélioration de cette capacité de prédiction (AUC ROC, 0,73; IC à 95 %, 0,78

Development and validation of a score to predict postoperative respiratory failure in a multicentre European cohort

“…2 In other clinical settings, a low SpO 2 is emerging as a good predictor of outcome. 33,34 The incidence of SpO 2 of 95% or less in our surgical cohort (18.8%) was much higher than the incidence of 6.3% in a recent population-based study. 35 We interpret this as a sign that the surgical population will tend towards impaired cardiorespiratory function.…”

Preventing deaths due to the hypertensive disorders of pregnancy

“…We have assessed the performance of maternal symptoms, proteinuria, oxygen saturation by pulse oximetry (SpO 2 ), uric acid, platelet counts and liver tests individually to identify those hypertensive pregnant women who are more likely to suffer severe complications [73], [74], [75], [76], [77], [78]. Of these, only SpO 2 showed any capacity as a test that can be used in isolation, including predicting non-cardiorespiratory adverse maternal outcomes (area under the receiver-operator characteristic (AUC ROC) >0.7) [77].…”

“…Of these, only SpO 2 showed any capacity as a test that can be used in isolation, including predicting non-cardiorespiratory adverse maternal outcomes (area under the receiver-operator characteristic (AUC ROC) >0.7) [77]. Therefore, we deemed that multivariable models were required.…”

An mHealth monitoring system for traditional birth attendant-led antenatal risk assessment in rural Guatemala

“…In addition to fetal heart rate abnormalities, indicative of fetal distress, maternal blood pressure and oxygenation levels are reviewed with the primary aim of detecting pre-eclampsia [24]–[26]. The logic triggering an alert given the requisite heart rate, oxygen saturation and blood pressure is outlined in table III.…”