title: 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.
  
  
  METHODS
  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/FiO2ratio 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.
  
  
  BACKGROUND
  None declared.
authors.affiliation: "Mónica Pretelini Sáenz" Maternal-Perinatal Hospital (HMPMPS), Instituto de Salud del Estado de México (ISEM).. Paseo Tollocan, Moderna de la Cruz, 50180 Toluca, México.
authors.forename: Lourdes A
authors.initials: LA
authors.lastname: Blanco Esquivel
authors.affiliation: "Mónica Pretelini Sáenz" Maternal-Perinatal Hospital (HMPMPS), Instituto de Salud del Estado de México (ISEM).. Paseo Tollocan, Moderna de la Cruz, 50180 Toluca, México.
authors.forename: Jorge Macia
authors.initials: JM
authors.lastname: Urbina
authors.affiliation: "Mónica Pretelini Sáenz" Maternal-Perinatal Hospital (HMPMPS), Instituto de Salud del Estado de México (ISEM).. Paseo Tollocan, Moderna de la Cruz, 50180 Toluca, México; Ciprés Grupo Médico (CGM) and Asociación Científica Latina (ASCILA). Felipe Villanueva sur 700, Col. Morelos, 50120, Toluca, México.
authors.forename: Hugo Mendieta
authors.initials: HM
authors.lastname: Zerón
mesh_terms: D000328:Adult; D005260:Female; D005865:Gestational Age; D006801:Humans; D008428:Maternal Mortality; D008800:Mexico; D007744:Obstetric Labor Complications / Q000401:mortality*; D063305:Organ Dysfunction Scores; D011237:Predictive Value of Tests; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality*; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D061665:Time-to-Treatment; D055815:Young Adult
keywords: Intensive Care Units; Sequential Organ Failure; maternal mortality