Applicability of WHO Maternal Severity Score (MSS) and Maternal Severity Index (MSI) Model to predict the maternal outcome in near miss obstetric patients: a prospective observational study

Pandit, R. K.; Jain, Vanita; Bagga, Rashmi; Sikka, Pooja; Jain, Kajal

doi:10.1007/s00404-019-05159-z

Cited by 5 publications

(9 citation statements)

References 12 publications

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“…Hysterectomy for bleeding or uterine sepsis is performed as a critical intervention and early hysterectomy for such complications is reported to decrease mortality. [ 28 29 ] Multiorgan failure is a major predictor of mortality [ 20 30 ] Similar to a previous study, the present study observed that mortality increased with the involvement of more than two organ systems. [ 19 ]…”

Section: Discussionsupporting

confidence: 86%

“…[ 4 ] As reported previously, the present study also observed that most criteria in the cardiovascular and respiratory systems, if present at admission to PACU, were significantly associated with mortality. [ 28 ] Renal dysfunction secondary to preeclampsia is reported to improve after the termination of pregnancy. [ 28 ] Acute kidney injury secondary to sepsis was the cause of death in one of our patients with renal dysfunction.…”

Section: Discussionmentioning

confidence: 99%

“…[ 28 ] Renal dysfunction secondary to preeclampsia is reported to improve after the termination of pregnancy. [ 28 ] Acute kidney injury secondary to sepsis was the cause of death in one of our patients with renal dysfunction.…”

Section: Discussionmentioning

confidence: 99%

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Retrospective analysis of patients with severe maternal morbidity receiving anaesthesia services using 'WHO near miss approach' and the applicability of maternal severity score as a predictor of maternal outcome

2020

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Background and Aims: Risk stratification of severely morbid obstetric patients receiving anaesthesia services can be helpful in improving maternal outcomes. This study was undertaken to analyse these patients using the WHO near-miss (NM) approach and to assess the applicability of maternal severity score (MSS) to predict maternal mortality. Methodology: This is a one-year retrospective cohort analysis at a tertiary care centre. Of all the obstetric patients receiving anaesthesia, those with 'potentially life-threatening conditions' (PLTC) were identified. Amongst women with PLTC, those fulfilling the WHO NM criteria were grouped into either maternal near miss (MNM) or maternal death (MD) depending on final survival outcome. The MSS was assessed upon admission to post-anaesthesia ICU. The cases of “near miss” were compared to maternal death to determine the factors and WHO NM criteria significantly associated with mortality. Area under ROC curve (AUROC) was used to assess the accuracy of MSS to predict maternal mortality. Results: Of the 4351 anaesthetised obstetric patients, 301 were PLTC, 59 MNM and 11 MD. Obstetric haemorrhage was the commonest PLTC with the highest risk for MNM and MD. Preoperative organ dysfunction, referral from other centres, intra-uterine fetal death (IUFD) and WHO cardiovascular and respiratory NM criteria were significantly associated with mortality. MSS had excellent accuracy for the prediction of mortality (AUROC was 0.986 and 95% CI 0.966–0.996). Conclusion: Haemorrhage is the leading cause of MNM and MD. MSS is reliable in stratifying the severity of maternal morbidity and in predicting maternal mortality. Thus it can be used as an effective prognostic tool.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

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Retrospective analysis of patients with severe maternal morbidity receiving anaesthesia services using 'WHO near miss approach' and the applicability of maternal severity score as a predictor of maternal outcome

2020

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“… 6 10 Limited studies are available in the literature validating the usefulness of the MSI, especially from low-income to middle-income countries. 11 12 We aimed to perform an external validation of the MSI in predicting maternal deaths among pregnant women with potentially life-threatening complications during pregnancy or childbirth.…”

Section: Introductionmentioning

confidence: 99%

External validation of the Maternal Severity Index for predicting maternal death following potentially life-threatening complications during pregnancy and childbirth: a single-centre, prospective observational study

et al. 2022

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ObjectivesTo perform an external validation to assess the usefulness of the Maternal Severity Index (MSI) in predicting maternal death among women with potentially life-threatening complications during pregnancy or childbirth.DesignProspective observational study.SettingA tertiary referral centre in southeastern India.Participants1833 women with potentially life-threatening complications identified using the WHO criteria.Predictor assessedMSI calculated based on the severity markers of the WHO criteria for maternal near-miss.Primary outcomeMaternal death.Statistical analysisReceiver operating characteristics (ROC) curve analysis was performed to assess discriminative performance, and agreement between expected and observed deaths was plotted to determine calibration.ResultsThe incidence of severe maternal outcomes was 10 per 1000 live births. There were 57 (151 per 100 000 live births) maternal deaths during the study period. Maternal Severity Score was significantly higher among those who died (2.8±1.3 vs 2.0±1.2, p<0.001). The mean MSI value was 1.03% (95% CI 0.7% to 1.2%). ROC curve analysis showed good discrimination (AUC(Area Under the Curve): 0.962, 95% CI 0.952 to 0.970); however, overfitting was seen with higher probabilities. The standardised mortality ratio (SMR) was 0.02 (95% CI 0.01 to 0.02), indicating good quality of care.ConclusionsThe MSI has good discriminative performance in distinguishing who succumbs to life-threatening complications, but needs recalibration to avoid overfitting. SMR of less than 0.5 indicates fewer than expected deaths, suggesting good quality of care in reducing maternal mortality in the study population.

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“…Um estudo retrospectivo e observacional australiano, sob a premissa daquele país apresentar uma baixa razão de MM já em 2014 (8,7 óbitos por 100.000 nascidos vivos), percebeu pouco conhecer sobre a morbidade do público materno atendido em suas UTI. (SOUZA et al, 2013;HADDAD et al, 2014;PANDIT et al, 2019 A assistência pré-natal foi ampliada no país ao longo dos anos, mas a qualidade e a adequada cobertura são questionadas por estudos brasileiros (MARIA et al, 2016;SAINTRAIN et al, 2016) (ACOSTA et al, 2016). Na maternidade Ana Braga, houve diferença significativa dentre as medianas avaliadas, com maior paridade dentre as mulheres adultas quando também avaliadas as médias, 40,9% nulíparas (22,1% dentre as adultas e 85,6% dentre as adolescentes), 17,9% primíparas (21,1% dentre as adultas e 10,1% dentre as adolescentes) e 41,2% multíparas (56,8% dentre as adultas e 4,3% dentre as adolescentes), onde percebemos uma diferença esperada na maior proporção de multíparas encontradas na maternidade do Brasil comparada a do Reino Unido.…”

Section: Diferença Média (Ic95%)unclassified

Comparação dos desfechos de mulheres adolescentes e adultas atendidas na Unidade de Terapia Intensiva de uma maternidade de referência da cidade de Manaus - Amazonas

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Eu te amo com uma calma transparente Ainda que percebas as minhas angústias Como se fosses de mim minha parente, Eu me preocupo contigo e tu me escutas Ainda te amo, como se não tivesse escolha E nem mais coisas a amar tivesse em vida E para que o que sinto em mim não encolha, Eu não me canso de amar-te em demasia Mas pode uma calma caber em exageros Em que me lanço assim a ti, tão diuturno? Durmo e sonho escutando esse barulho Desses efêmeros sinais vitais em exaspero Fazendo minh' alma conhecer um obscuro, Apaixonado e sonoro tum-tá que sai ligeiro.

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Applicability of WHO Maternal Severity Score (MSS) and Maternal Severity Index (MSI) Model to predict the maternal outcome in near miss obstetric patients: a prospective observational study

Cited by 5 publications

References 12 publications

Retrospective analysis of patients with severe maternal morbidity receiving anaesthesia services using 'WHO near miss approach' and the applicability of maternal severity score as a predictor of maternal outcome

Retrospective analysis of patients with severe maternal morbidity receiving anaesthesia services using 'WHO near miss approach' and the applicability of maternal severity score as a predictor of maternal outcome

External validation of the Maternal Severity Index for predicting maternal death following potentially life-threatening complications during pregnancy and childbirth: a single-centre, prospective observational study

Comparação dos desfechos de mulheres adolescentes e adultas atendidas na Unidade de Terapia Intensiva de uma maternidade de referência da cidade de Manaus - Amazonas

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