Background:
To study physiological and biochemical
parameters to predict serious adverse maternal outcomes and to develop
risk score using above
parameters.
Methods:
This
prospective study was conducted in 500 high
risk pregnant women attending
tertiary care teaching hospital. We noted physiological and biochemical
parameters as soon as they were available .The primary
outcome measures was “severe adverse maternal outcome(SAMO)” in form of one or more among
mortality, near miss
morbidity and ICU admissions.
Results:
Out-off 500
women, severe adverse maternal outcomes were seen in 158 (31.6%)
women. Most common cause of near miss maternal
morbidity was hypertensive
disease of
pregnancy (62.7%) followed by major obstetric
hemorrhage (18.9%). There were 33(6.6%) ICU admission, 23 (4.6%)
maternal death and 153 (30.6%) near miss maternal
morbidity. The most common cause of
maternal death in our study was obstetric
hemorrhage. The significant variables after
multivariate analysis [temp,
pulse,
urine protein] were used to devise a Maternal
early warning score (MEWS) based on physiological
parameters at score value of ≥1/6 was found to have
sensitivity of 70% and
specificity of 82% in predicting SAMO with AUROC of 0.76. The significant
laboratory parameters after
multivariate analysis were
blood urea,
serum creatinine,
serum bilirubin and
liver enzymes. The obstetric
risk score (Maternal
risk prediction score MRPS) which incorporated of these
laboratory parameters in addition to physiological
parameters has
sensitivity of 82% and
specificity of 75% with AUROC 0.79 value ≥ 2/18.
Conclusions:
The addition of laboratotory
parameters to physiological variables improves performance of
risk score to predict SAMO.