title: Organ dysfunction and organ failure as predictors of outcomes of severe maternal morbidity in an obstetric intensive care unit.
abstract: BACKGROUND
  Most of the maternal deaths are preceded by severe maternal morbidity (SMM). Organ dysfunction and organ failure may occur as part of the pathophysiologic spectrum in SMM.
  
  
  OBJECTIVE
  To determine the predictive and discriminative abilities of the Sequential Organ Failure Assessment (SOFA) scores to determine outcomes in pregnant women with SMM, who were admitted to a maternal ICU.
  
  
  METHODS
  A retrospective study design was used to ascertain the diagnostic effectiveness of Sequential Organ Failure Assessment (SOFA) scores. Maximum individual SOFA scores and total maximum SOFA score were compared between women with and without SMM, and in women with SMM who survived or did not survive. Primary outcome measure of interest was maternal mortality.
  
  
  RESULTS
  A majority (n=73, 85.88%) of the 85 women in the study had obstetrics related causes. The total maximum SOFA score was significantly higher in women with SMM as compared to that in women without SMM (p<0.001). The total maximum SOFA score showed ability to discriminate pregnant women with SMM who would not survive (AUROC 0.77, 95% CI: 0.46, 1.00). The positive likelihood ratios and accuracy for total SOFA scores of ≥10 and ≥12 were 19.20 and 38.40, and 94.20% and 95.65% respectively. The post-test probabilities for maternal deaths in women with SMM for SOFA scores ≥10 and ≥12 were 60.01% and 75.01% respectively.
  
  
  CONCLUSIONS
  The total maximum SOFA score showed good predictive and discriminative abilities for maternal mortality in pregnant women with SMM, who were admitted to ICU.
authors: Consultant, Department of Obstetrics, Fernandez Hospital , Hyderabad, India .
authors: Sailaja Devi
authors: SD
authors: Kallur
authors: Research Associate, Obstetric Medicine, Fernandez Hospital , Hyderabad, India .
authors: Vidyavati
authors: V
authors: Patil Bada
authors: Consultant, Department of Obstetrics, Fernandez Hospital , Hyderabad, India .
authors: Pratibha
authors: P
authors: Reddy
authors: Head, Department of Anesthesia, Critical Care and Pain Medicine, Fernandez Hospital , Hyderabad, India .
authors: Sunil
authors: S
authors: Pandya
authors: Head, Department of Woman and Child Health Research, Fernandez Hospital , Hyderabad, India .
authors: Praveen K
authors: PK
authors: Nirmalan
keywords: ICU; Organ Dysfunction; Organ Failure; SOFA scores; Severe Maternal Morbidity