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Prognosticating Fetomaternal ICU Outcomes.

Jyotsna Suri1, Zeba Khanam1

  • 1Department of Obstetrics and Gynaecology, VMMC and Safdarjung Hospital, New Delhi, India.

Indian Journal of Critical Care Medicine : Peer-Reviewed, Official Publication of Indian Society of Critical Care Medicine
|May 26, 2022
PubMed
Summary

Predicting maternal outcomes in critically ill obstetric patients is challenging. Obstetric-specific scoring systems, like OEWS, are more accurate than general critical care models for improving maternal and fetal health outcomes.

Keywords:
DelaysFetomaternal outcomeICUMortalityMortality predictionObstetric critical carePredictive modelPregnancy

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Area of Science:

  • Critical care medicine
  • Obstetrics and Gynecology
  • Maternal-fetal medicine

Background:

  • Predicting maternal outcomes in critically ill obstetric patients lacks fully validated scoring systems.
  • General critical care scoring systems (e.g., APACHE, SAPS, MPM, MODS, LODS, SOFA) may overestimate mortality in obstetric patients due to pregnancy-related physiological changes.
  • Obstetric-specific scoring systems are designed to account for the unique physiology of pregnant individuals.

Purpose of the Study:

  • To review and compare the utility of various scoring systems for prognostication in critically ill obstetric patients.
  • To highlight the advantages of obstetric-specific models over general critical care models.
  • To emphasize the impact of maternal outcomes on fetal well-being.

Main Methods:

  • Review of existing literature on general critical care scoring systems (APACHE I-IV, SAPS I-III, MPM I-IV, MODS, LODS, SOFA) applied to obstetric patients.
  • Identification and discussion of obstetric-specific prediction models (MEOWS, OEWS, MEWT).
  • Comparison of the predictive accuracy of different models, particularly focusing on the Sequential Organ Failure Assessment (SOFA) for sepsis and the Obstetric Early Warning Score (OEWS) in intensive care unit (ICU) settings.

Main Results:

  • General scoring systems like APACHE II and Mortality Probability Model II are frequently used but may overpredict mortality.
  • The Sequential Organ Failure Assessment (SOFA) model shows promise for predicting sepsis in obstetric patients.
  • Obstetric Early Warning Score (OEWS) demonstrates comparable results to APACHE II and SOFA in ICU settings and is effective in identifying deteriorating patients in non-ICU settings.
  • Fetal outcomes are directly influenced by maternal outcomes.

Conclusions:

  • Obstetric-specific scoring systems offer more objective prognostication for critically ill obstetric patients.
  • The OEWS is a valuable tool for early detection of deterioration in both ICU and non-ICU settings.
  • Accurate maternal prognostication is crucial for estimating perinatal mortality and morbidity.