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Am J Perinatol 2019; 36(01): 008-014
DOI: 10.1055/s-0038-1626716
SMFM Fellowship Series Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A Prediction Model for Severe Maternal Morbidity in Laboring Patients at Term

Joshua I. Rosenbloom
1   Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
,
Methodius G. Tuuli
1   Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
,
Molly J. Stout
1   Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
,
Omar M. Young
1   Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
,
Candice L. Woolfolk
1   Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
,
Julia D. López
1   Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
,
George A. Macones
1   Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
,
Alison G. Cahill
1   Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
› Author Affiliations Funding This work was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01: HD 06161619–01A1), the Robert Wood Johnson Foundation Physician Faculty Scholars Program (66329), and the National Center for Research Resources Clinical and Translational Science Award (RR024992).
Further Information

Publication History

11 July 2017

29 December 2017

Publication Date:
08 February 2018 (online)

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Abstract

Objective To determine the factors associated with severe maternal morbidity in a modern cohort of women laboring at term and to create a prediction model.

Study Design This is a retrospective cohort study of all term, laboring patients with live births at a single tertiary care center from 2004 to 2014. The primary outcome was composite maternal morbidity including organ failure, amniotic fluid embolism, anesthesia complications, sepsis, shock, thrombotic events, transfusion, or hysterectomy. Multivariable logistic regression was used to identify independent risk factors. Antepartum, intrapartum, and combined risk scores were created and test characteristics were analyzed.

Results Among 19,249 women delivering during the study period, 323 (1.68%) patients experienced severe morbidity, with blood transfusion the most common complication (286, 1.49%). Factors in the antepartum model included advanced maternal age, race, hypertension, nulliparity, history of cesarean delivery, smoking, and unfavorable Bishop score. Intrapartum factors included mode of delivery, use of cervical ripening agents or oxytocin, prolonged second stage, and macrosomia. The combined model had an area under the curve of 0.76 (95% confidence interval [CI], 0.73, 0.79).

Conclusion This three-part risk scoring system can help clinicians counsel patients and guide clinical decision making for anticipating severe maternal morbidity and necessary resources.

Keywords

maternal morbidity - labor - risk score - outcome prediction

Note

This study was previously presented at the Pregnancy Meeting, Society for Maternal-Fetal Medicine, Las Vegas, NV January 25–28, 2017.