A comorbidity-based screening tool to predict severe maternal morbidity at the time of delivery

Easter, Sarah Rae; Bateman, Brian T.; Sweeney, Valerie; Manganaro, Karen; Lassey, Sarah C.; Gagne, Joshua J.; Robinson, Julian N.

doi:10.1016/j.ajog.2019.06.025

Cited by 81 publications

(81 citation statements)

References 31 publications

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“…The area under the receiver operating characteristic curve in predicting SMM using the risk stratification approach was 68% in the current study. In the United States, the areas under the curve in studies that used comorbidity index to predict SMMwere 78% [56], 65% [60], and 70% [65]. These were similar to that of the current study.…”

Section: Plos Onesupporting

confidence: 86%

High-risk pregnancies and their association with severe maternal morbidity in Nepal: A prospective cohort study

2020

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Background The early identification of pregnant women at risk of developing complications at birth is fundamental to antenatal care and an important strategy in preventing maternal death. This study aimed to determine the prevalence of high-risk pregnancies and explore the association between risk stratification and severe maternal morbidity. Methods This hospital-based prospective cohort study included 346 pregnant women between 28–32 gestational weeks who were followed up after childbirth at Koshi Hospital in Nepal. The Malaysian antenatal risk stratification approach, which applies four color codes, was used: red and yellow denote high-risk women, while green and white indicate low-risk women based on maternal past and present medical and obstetric risk factors. The World Health Organization criteria were used to identify women with severe maternal morbidity. Multivariate confirmatory logistic regression analysis was performed to adjust for possible confounders (age and mode of birth) and explore the association between risk stratification and severe maternal morbidity. Results The prevalence of high-risk pregnancies was 14.4%. Based on the color-coded risk stratification, 7.5% of the women were categorized red, 6.9% yellow, 72.0% green, and 13.6% white. The women with high-risk pregnancies were 4.2 times more likely to develop severe maternal morbidity conditions during childbirth. Conclusions Although smaller in percentage, the chances of severe maternal morbidity among high-risk pregnancies were higher than those of low-risk pregnancies. This risk scoring approach shows the potential to predict severe maternal morbidity if routine screening is implemented at antenatal care services. Notwithstanding, unpredictable severe maternal morbidity events also occur among low-risk pregnant women, thus all pregnant women require vigilance and quality obstetrics care but high-risk pregnant women require specialized care and referral.

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Section: Plos Onesupporting

confidence: 86%

High-risk pregnancies and their association with severe maternal morbidity in Nepal: A prospective cohort study

2020

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“…Despite the low sensitivity of the maternal comorbidity index to predict SMM, the c-statistic of the maternal comorbidity index was similar to the original study that developed the index (area under the curve = 0.66) 12 and the validation study (area under the curve = 0.67). 14 In addition, clinical use for the index is promising and has been validated in a prospective clinical study (c-statistic = 0.83) 13,15 ; however, the clinical study modified the comorbidity index to include conditions that have been shown to be associated with SMM, such as prepregnancy obesity and morbidly adherent placenta. The authors of the current study also agree that the maternal comorbidity index score needs to be modified to include these other comorbid conditions, including individual-level social risk factors and hospital-level factors to appropriately flag women that are at high risk for adverse birth outcomes, when used in a clinical setting.…”

Section: Discussionmentioning

confidence: 99%

“…It can also be used to track patients’ burden of comorbidities across practitioners, institutions, and geographic level . The maternal comorbidity index has been validated in multiple studies, including one study conducted in a hospital in Alberta, Canada, and one study conducted in a single, tertiary‐care, academic hospital in the United States, both using clinical data linked to hospital administrative data; however, both noted that the generalizability of the index was unknown and needed to be examined. In addition, a national study examined the association between maternal comorbidity index and SMM using hospital administrative data, but they limited their sample to only low‐delivery‐volume (<1000) hospitals .…”

Section: Introductionmentioning

confidence: 99%

“…Maternal early warning system can be implemented during the antenatal to postpartum periods, but it is primarily implemented in hospital settings when a patient is admitted . In contrast, the maternal comorbidity index can be used to detect high‐risk women, even before pregnancy, for example, during preconception care in primary care settings, as it captures chronic conditions in addition to pregnancy‐induced conditions, and can be used to refer these high‐risk women to higher level of care . To that end, the objective of this study was to examine the association between maternal comorbidity index and SMM among delivery hospitalizations in Texas.…”

Section: Introductionmentioning

confidence: 99%

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Maternal comorbidity index and severe maternal morbidity during delivery hospitalizations in Texas, 2011‐2014

Salahuddin

Mandell

Lakey

et al. 2019

Birth

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Background Severe maternal morbidity (SMM) prevalence was 194.0 per 10 000 deliveries in Texas in 2015. Chronic, behavioral, and pregnancy‐induced conditions, as captured by a maternal comorbidity index, increase the risk for delivery‐related morbidity and mortality. The objective of the study was to examine the association between maternal comorbidity index and SMM among delivery hospitalizations in Texas. Methods Delivery‐related hospitalizations among Texan women aged 15‐49 years were identified using the 2011‐2014 Texas all‐payer inpatient hospitalization public use data files (n = 1 434 441). The primary outcome of interest was SMM, based on the Alliance for Innovation on Maternal Health's coding scheme. The exposure of interest was a maternal comorbidity index. Multivariable logistic regression model was used to examine the association between maternal comorbidity index and SMM. Results SMM prevalence remained consistent between 2011 and 2014 (196.0‐197.0 per 10 000 deliveries, P > .05; n = 1 434 441). Nearly 40% of delivery‐related hospitalizations had a maternal comorbidity index of at least 1, and the proportion of deliveries in the highest risk category of comorbidity index (≥5) increased by 12.0% from 2011 to 2014. SMM prevalence was highest among the youngest and oldest age groups. With each unit increase in maternal comorbidity index, the odds of SMM increase was 1.43 (95% CI 1.42‐1.43). Conclusions Maternal comorbidity index is associated with SMM; however, the low predictive power of the model suggests that other, unmeasured factors may influence SMM in Texas. These findings highlight a need to understand broader contextual factors (practitioner, facility, systems of care, and community) that may be associated with SMM to reduce maternal morbidity and mortality in Texas.

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“…The use of epidural analgesia for labor in the United States was 73.1% in 2015, and as high as 86% at an academic tertiary center. (3,4) Epidural analgesia has been deployed in Vietnam in the past decade, but the technique is not uniformly covered by Vietnamese health insurance and many women remain unaware of this option.…”

Section: Introductionmentioning

confidence: 99%

Sociodemographic factors associated with request for labor epidural analgesia in a tertiary obstetric hospital in Vietnam

Nguyen

Farber

Phan

et al. 2020

Preprint

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Background Labor epidural pain relief remains underutilized in developing countries and may serve as a marker of health care access disparity. Here we examine the sociodemographic factors associated with the utilization of labor epidural analgesia at a large obstetrics and gynecology hospital in Vietnam.Methods This was a cross-sectional study of women who underwent vaginal delivery in September 2018 at the Hanoi Obstetrics and Gynecology Hospital. Utilization of epidural analgesia during labor was determined. Univariate and multivariate regression models were applied to evaluate the association between patient demographic and socioeconomic factors and request for labor epidural analgesia.Results A total of 417 women had vaginal deliveries during the study period. 207 women (49.6%) utilized epidural analgesia for pain relief during labor and 210 did not. Parturients more likely to utilize labor epidurals were older than 35 years of age (OR 2.84, 95% CI 1.11-8.17), multiparous (OR 2.8 95% CI 1.85-4.25), from an urban area, with higher income (OR 6.47, 95% CI 2.59-19.23), and with higher level of education.ConclusionsFactors related to a parturient’s request for epidural analgesia during labor at our tertiary obstetric hospital included include age greater than 35 years, multiparity, and high income and education levels. Educational outreach to women about the benefits of epidural analgesia can target women who do not share these demographics.

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A comorbidity-based screening tool to predict severe maternal morbidity at the time of delivery

Cited by 81 publications

References 31 publications

High-risk pregnancies and their association with severe maternal morbidity in Nepal: A prospective cohort study

High-risk pregnancies and their association with severe maternal morbidity in Nepal: A prospective cohort study

Maternal comorbidity index and severe maternal morbidity during delivery hospitalizations in Texas, 2011‐2014

Sociodemographic factors associated with request for labor epidural analgesia in a tertiary obstetric hospital in Vietnam

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