Approach to an obstetric prognosis scale: The modified SOFA scale

Abstract

Background: Severe obstetric morbidity constitutes a serious problem worldwide; however, an effective obstetrical prognosis scale is still missing. Objective: To propose a modified Sequential Organ Failure Assessment Score (SOFA) score based on time before reaching specialized medical attention. Method: 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. Results: 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. Conclusions: 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.