Approach to an obstetric prognosis scale: The modified SOFA scale

Abstract

Severe obstetric morbidity constitutes a serious problem worldwide; however, an effective obstetrical prognosis scale is still missing. To propose a modified Sequential Organ Failure Assessment Score (SOFA) score based on time before reaching specialized medical attention. This was an ambispective, descriptive study, including all women treated at the Obstetrical Intensive Care Unit (OICU) of the "Mónica Pretelini Sáenz" Maternal-Perinatal Hospital (HMPMPS), Toluca, Mexico, from June 2009 to June 2013. The patient's SOFA score and clinical evolution were registered daily. A modified obstetrical SOFA scale was constructed adjusting the value of 180 instead of 200 in the punctuation column of 3 for the PaO2/FiO2 ratio and adding a file of disease evolution time with sepsis prior to reaching specialized medical attention. Two hundred thirty two patients, with an average age (SD) of 26.42 (±7.54) years, mean gestational age of 33 (±7.5) weeks were included in the study; 118 suffered from pre-eclampsia, 56 obstetric haemorrhages, 41 eclampsia (25 preceded by pre-eclampsia) and 23, sepsis. ROC curves showed a higher area under the curve (AUC) for the modified SOFA (0.868; p<0.001) than SOFA (0.796; p=0.003), in the prediction of maternal mortality. The SOFA score, taking into account a lower value for the Kirby index and a threshold time of 12-h with sepsis before getting specialized medical attention, shows a good predictive value for maternal death and could be considered for evaluating the severity of complicated obstetrical patients. None declared.