The critically ill obstetric patient: what's the score?

Gopalan, P D; Muckart, D. J. J.

doi:10.1016/j.ijoa.2004.04.005

Cited by 21 publications

(14 citation statements)

References 16 publications

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“…The MEOWS has been widely promoted in maternity since 2007 as an effective patient safety strategy by policy makers, safety and clinical leads,1 3 27 28 despite little evidence of its predictive value or utility 29. Indeed, the physiological changes of pregnancy and the early postnatal period may render existing MEOWS inappropriate 30. Inclusion of the MEOWS as a CNST standard has further endorsed its use 4.…”

Section: Discussionmentioning

confidence: 99%

Value of a modified early obstetric warning system (MEOWS) in managing maternal complications in the peripartum period: an ethnographic study

et al. 2013

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ObjectiveTo explore implementation of the modified early obstetric warning system (MEOWS) in practice to further understanding about the influence of contextual factors DesignEthnographic study using observations (>120 hours), semi-structured interviews (45) and documentary review over a 7 month period; data was analysed thematically Setting Maternity services in two UK hospitals Participants Doctors, midwives, and managers ResultsFor women admitted to hospital in the antenatal and postnatal period with established risk of morbidity, the MEOWS enabled communication about vital signs from junior to senior midwives and obstetricians. The trigger prompts helped shape shared understandings of maternal complications.However, midwifery and obstetric staff questioned the added value of an extra chart in the postnatal period given the low incidence of maternal complications, and the resulting increase in workload. In an effort to prioritise workload demands and respond to the immediate needs of both women and their babies, midwives exercised professional discretion regarding its use. However, discretionary use of MEOWS meant the loss of a potential universal safety net for detection of deterioration. ConclusionDespite a decade of use in acute settings, research into the effectiveness of early warning systems still yields conflicting results. Widespread policy support for the MEOWS is based on its intuitive appeal and no validated system for use in the maternity population currently exists. Our findings suggest that while the MEOWS has value in structuring the surveillance of hospitalised women with 3 established risk of morbidity, the complexities of managing risk and safety within the maternity pathway, the MEOWS' associated opportunity costs, and variation in implementation currently call into question its role for routine use.

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Section: Discussionmentioning

confidence: 99%

Value of a modified early obstetric warning system (MEOWS) in managing maternal complications in the peripartum period: an ethnographic study

et al. 2013

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“…This challenge necessitates identification and validation of population-specific scores for organ/system dysfunction in patients with obstetric morbidity. The SOFA score offers several advantages [26][27][28][29][30]: it uses variables that can be easily measured without the need of very complex resources, proxy measures could be used in cases where complex or expensive variables cannot be measured, measurements can easily be standardized, and scores have high predictive and discriminatory ability in SMM. As in other studies [12][13][14][21][22][23][24]26], the maximum aggregated SOFA scores were prognostic, though in retrospect.…”

Section: Discussionmentioning

confidence: 99%

The Utility of the Sequential Organ Failure Assessment Score in Predicting Mortality in Critically Ill Obstetric Patients Admitted to a High Dependency Unit in Uganda

Kaye¹

2017

IPCB

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Background: Most maternal deaths result from severe maternal morbidity (SMM with subsequent organ/system dysfunction and organ failure. The objective was to assess the performance of Sequential Organ Failure Assessment (SOFA) score in cases of SMM admitted to the high dependency obstetric unit.Methods: Organ/system dysfunction and failure were assessed according to the maximum score for the six components (respiratory, neurological, renal, hepatic, cardiovascular and coagulation system). The total maximum SOFA score was estimated using the worst result each component on a single day. The distribution of SOFA scores was assessed for normality by using the Shapiro Wilk Test, [p=003]. The mean maximum SOFA scores for each organ/system were computed according to according to outcome (survival or death), using the Mann-Whitney test. The sensitivity, specificity, and the area under the curve (AUC) for each organ/system were evaluated. A Receiver Operator Characteristic (ROC) curve was fitted using maximum likelihood estimates for the total maximum SOFA score, in order to assess the sensitivity, specificity and discriminatory abilities of the maximum SOFA scores. Results:Of the 425 patients with SMM, 345 (81.2%, 95%CI 71.8-82.4) survived while 80 (18.8%, 95% CI: 12.9, 22.6) did not survive. All the non-survivors and 64 (18.5%) of the survivors presented with multiple organ/system dysfunction. Nonsurvivors were more likely to present with more severe and with multiple organ/ system dysfunction. The maximum total SOFA score had good discrimination in the respiratory, cardiovascular and neurological systems, but poor discrimination in the renal, hepatic and coagulatory systems. The total maximum SOFA score displayed an area under the curve (AUC) of 0.83 (95% CI: 0.56, 1.00), with a cutoff value of at least 8.0 sensitivity of 86.7%, and specificity of 90.0%. Conclusion:The total maximum SOFA score showed good predictive and discriminative abilities for maternal mortality in women with severe maternal morbidity.

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“…[182223] Though we commonly employ Acute physiological and Chronic Health Evaluation II (APACHE II) score to assess the severity and prognosis, other scores like Glasgow Coma Scale and different scores related to individual organ dysfunctions are far better predictors of prognosis and severity when measured in combination.…”

Section: Discussionmentioning

confidence: 99%

Is intensive care the only answer for high risk pregnancies in developing nations?

Bajwa

Kaur

et al. 2010

J Emerg Trauma Shock

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Background:Management of high risk obstetric patients.Aim:The present study was conducted to evaluate the primary causes of the admission of obstetric patients to Intensive Care Unit (ICU), the presence of co-morbid diseases, outcome of such patients, their survival rate as well as the factors which contribute to the maternal mortality.Settings and Design:A retrospective study was conducted in the Department of Obstetrics and Gynaecology and Anaesthesiology/ICU of our Institute.Materials and Methods:Sixty-one obstetric patients, who were admitted to ICU between 20 December 2006 and 31 January 2010, were evaluated for various factors responsible for their admission as well as their outcome.Statistical Analysis:At the end of study, the data were arranged systematically and subjected to statistical analysis using nonparametric tests and P value <0.05 was considered significant.Results:Majority of the 61 patients admitted in ICU were referred from the peripheral health centers, smaller nursing homes/hospitals and some even without proper primary care and mainly comprising uneducated and rural population. Hemorrhage, pregnancy induced hypertension, cardiac diseases, respiratory insufficiency and sepsis were the main causes for admission. A total of 18 patients among 61 died during their ICU stay in the hospital.Conclusions:In the developing countries, high risk pregnancy should be managed at peripheral centers with proper facilities, antenatal visits and timely referral. The intensive care help should be reserved for very high risk pregnancies with co-morbid diseases.

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The critically ill obstetric patient: what's the score?

Cited by 21 publications

References 16 publications

Value of a modified early obstetric warning system (MEOWS) in managing maternal complications in the peripartum period: an ethnographic study

Value of a modified early obstetric warning system (MEOWS) in managing maternal complications in the peripartum period: an ethnographic study

The Utility of the Sequential Organ Failure Assessment Score in Predicting Mortality in Critically Ill Obstetric Patients Admitted to a High Dependency Unit in Uganda

Is intensive care the only answer for high risk pregnancies in developing nations?

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