Approach to an obstetric prognosis scale: The modified SOFA scale

Area of Science:

• Obstetrics and Gynecology
• Critical Care Medicine
• Maternal Health

Background:

• Severe obstetric morbidity is a significant global health concern.
• Existing prognostic scales lack effectiveness in obstetrics.
• There is a need for improved tools to predict maternal mortality.

Purpose of the Study:

• To develop and validate a modified Sequential Organ Failure Assessment (SOFA) score tailored for obstetric patients.
• To incorporate the time to specialized medical attention into the SOFA score for enhanced prognostic accuracy.
• To evaluate the modified SOFA score's ability to predict maternal mortality.

Main Methods:

• An ambispective, descriptive study was conducted involving women in an Obstetrical Intensive Care Unit (OICU).
• Data collected included daily SOFA scores and clinical evolution over four years.
• A modified SOFA scale was created by adjusting the PaO2/FiO2 ratio threshold and adding sepsis evolution time.

Main Results:

• The study included 232 obstetric patients with various complications like pre-eclampsia, hemorrhage, eclampsia, and sepsis.
• The modified SOFA score demonstrated a higher area under the curve (AUC) of 0.868 compared to the standard SOFA score (0.796) in predicting maternal death.
• The modified score's predictive accuracy for maternal mortality was statistically significant (p<0.001).

Conclusions:

• The modified SOFA score, considering a lower Kirby index value and a 12-hour sepsis threshold, effectively predicts maternal death.
• This modified obstetrical SOFA scale can be a valuable tool for assessing the severity of complicated obstetric cases.
• Further consideration of this modified score is recommended for clinical evaluation of high-risk obstetric patients.