Exploring Epidemiological Aspects, Distribution of WHO Maternal Near Miss Criteria, and Organ Dysfunction Defined by SOFA in Cases of Severe Maternal Outcome Admitted to Obstetric ICU: A Cross-Sectional Study.

Antonio Francisco Oliveira Neto,Renato Teixeira Souza,Carolina Ribeiro Do Valle,Mary Angela Parpinelli,José Guilherme Cecatti,Maria Laura Costa

doi:10.1155/2018/5714890

Antonio Francisco Oliveira Neto, Renato Teixeira Souza + Show 4 more

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https://doi.org/10.1155/2018/5714890

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Abstract

Objective To explore the epidemiological aspects, to describe the frequency and distribution of WHO maternal near miss (MNM) criteria and the presence of organ dysfunction and failure measured by the maximum SOFA (Sequential Organ Failure Assessment) score (SOFA max) in cases of severe maternal outcome (SMO). Methods In an observational cross-sectional study performed between January 2013 and December 2015, 279 pregnant or postpartum women were admitted to an obstetric ICU (intensive care unit) in Brazil. MNM, maternal death (grouped as SMO), and potentially life-threatening conditions (PLTC) were defined according to WHO criteria. For categorical variables, a descriptive analysis was carried out. Frequency and distribution of WHO criteria, organ dysfunction, or failure defined by SOFA max were performed. Results WHO criteria identified 65 SMO and 214 PLTC. Management criteria were present in 58/65 (89.2%) while 61/65 (93.8%) of SMO cases had dysfunction or failure by SOFA. Conclusions The systematic evaluation of the organic function by SOFA max score identified the presence of organic dysfunction or failure in almost all SMO cases. Management criteria were present in all MD cases. Our results indicate the need for new studies evaluating the parameterization of the WHO laboratory criteria for values compatible with the definition of organic dysfunction by the SOFA to identify MNM.

Highlights

The concept of severe maternal outcome (SMO) is used to describe a woman who died or survived a life-threatening condition (LTC) during pregnancy or childbirth or in the first 42 days postpartum [1]
The aim of this study is to explore the epidemiological aspects, to describe the rate and distribution of WHO Maternal near miss (MNM) criteria and the presence of organ dysfunction or failure measured by the SOFA (Sequential Organ Failure Assessment) score in SMO cases admitted to an obstetric intensive care unit (ICU)
The exploratory nature of our study allowed us to conclude that a systematic evaluation of the organic function by SOFA max score identified the presence of dysfunction or organic failure in virtually all SMO cases

Summary

Introduction

The concept of severe maternal outcome (SMO) is used to describe a woman who died or survived a life-threatening condition (LTC) during pregnancy or childbirth or in the first 42 days postpartum [1]. Maternal near miss (MNM) identifies a group of women who are survivors of an LTC [1, 2]. MNM cases can provide useful information concerning the identification of delays, failures, and successes in the care of pregnant or postpartum women [5, 6]. Accurate definition of an LTC is the first essential step in understanding the factors contributing to SMO [1, 7]. It is well-known that organ dysfunction is one of the major determining factors of outcome [8]. Criteria based on the evaluation of organ function are considered the gold standard to detect SMO cases [1, 2]

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