title: A prediction score for maternal mortality in Senegal and Mali.
abstract: OBJECTIVE
  To develop and validate a maternal mortality score to identify patients at risk of in-hospital death in developing countries.
  
  
  METHODS
  We performed a prospective observational study in 46 referral hospitals in Senegal and Mali, starting October 1, 2007. Derivation of a maternal mortality score was performed, using generalized estimating equation, on patients included during the first 6 months of the study (301 deaths out of 43,624 deliveries) and validated on patients included during the next 6 months (345 deaths out of 46,328 deliveries).
  
  
  RESULTS
  Nine criteria were independently associated with maternal death: severe anemia in pregnancy, malaria diagnosed during pregnancy, parity greater than 4, fewer than three antenatal visits, referral from another health facility, antepartum or postpartum hemorrhage, preeclampsia or eclampsia, uterine rupture, and genital infection or sepsis. The maternal mortality score, ranging from 0 to 100, occupies an area under the receiver operating characteristics curve of 0.89 (95% confidence interval [CI] 0.87-0.91). The low-risk group for maternal mortality, based on a score less than 10, has a negative predictive value of 99.9% (95% CI 99.8-99.9) and a negative likelihood ratio of 0.18, ruling out maternal mortality with a probability of 0.13% (95% CI 0.09-0.17). Sensitivity of the score to identify patients at risk of in-hospital death was 85.0% (95% CI 80.5-88.8). Validation of the score yielded a sensitivity of 87.8% (95% CI 83.9-91.1), a negative predictive value of 99.9% (95% CI 99.8-99.9), and a probability of maternal death of 0.12% (95% CI 0.08-0.17) in the low-risk group.
  
  
  CONCLUSIONS
  : The maternal mortality score could help health care professionals to identify patients at risk of maternal mortality who need careful management.
  
  
  METHODS
  III.
authors: International Health Unit, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, the Centre de Recherche du CHU Sainte Justine, and the Department of Gynecology and Obstetrics, CHU Sainte Justine, Université de Montréal, and the Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada; the Institut de Recherche pour le Développement, Paris, France; Faculté de Pharmacie, Université Paris Descartes, Sorbonne Paris Cité, France; URFOSAME, Referral Health Center of Commune V, Bamako, Mali; and EA 7285 Risk and Safety in Clinical Medicine for Women and Perinatal Health, University of Versailles St-Quentin, Versailles, France.
authors: Cyrille
authors: C
authors: Huchon
authors: Alexandre
authors: A
authors: Dumont
authors: Mamadou
authors: M
authors: Traoré
authors: Michal
authors: M
authors: Abrahamowicz
authors: Arnaud
authors: A
authors: Fauconnier
authors: William
authors: W
authors: Fraser
authors: Pierre
authors: P
authors: Fournier
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008302:Mali / Q000453:epidemiology; D008428:Maternal Mortality; D011247:Pregnancy; D011446:Prospective Studies; D018570:Risk Assessment; D012675:Senegal / Q000453:epidemiology
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