Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160011, India.
Department of Reproductive Medicine, Cloudnine Hospital, Bangalore, India.
Arch Gynecol Obstet. 2019 Jul;300(1):49-57. doi: 10.1007/s00404-019-05159-z. Epub 2019 Apr 11.
To assess the applicability of WHO Maternal Severity Score (MSS) and Maternal Severity Index (MSI) Model in near miss (NM) obstetric patients METHODS: It was a prospective observational study conducted at a tertiary health care center from July 2015 to Feb 2016. All patients fulfilling one or more WHO NM criteria were included. MSS and MSI were calculated for all NM patients on admission. They were then followed up till the final outcome (NM or death). Each NM parameter, system-wise MSS, total MSS and MSI were then associated with the final outcome.
Of 4822 patients, 1739 had potentially life-threatening conditions of which 174 were identified as NM. The average MSS and MSI of patients who remained NM was 4.41 and 11.67%, respectively, and those who died was 9.47 and 58.16%, respectively. Both were found to be significantly associated with the outcome (p < 0.001). MSI had good accuracy for maternal death prediction in women with markers of organ dysfunction (AUROC - 0.838 [95% CI 0.766-0.910]). However, of 25 NM criteria, only 17 NM criteria and 3 system dysfunctions (cardiovascular, respiratory and neurological) were found to associate significantly with the outcome.
MSS and MSI act as good prognostic tools to assess the severity of maternal complications and estimate the probability of death in NM patients. As all NM parameters are not equally predictive of severity of maternal morbidity, different scores per NM parameter and system should be assigned while calculating MSS for better prognostication.
评估世界卫生组织（WHO）产妇严重程度评分（MSS）和产妇严重程度指数（MSI）模型在接近死亡病例（NM）产科患者中的适用性。
这是一项于 2015 年 7 月至 2016 年 2 月在一家三级保健中心进行的前瞻性观察性研究。所有符合一个或多个 NM 标准的患者均被纳入。对所有 NM 患者入院时计算 MSS 和 MSI。然后对其进行随访，直至最终结局（NM 或死亡）。随后将每个 NM 参数、系统 MSS、总 MSS 和 MSI 与最终结局相关联。
在 4822 名患者中，有 1739 名患者有潜在的危及生命的情况，其中 174 名被确定为 NM。NM 患者中仍为 NM 的患者的平均 MSS 和 MSI 分别为 4.41%和 11.67%，而死亡患者分别为 9.47%和 58.16%。两者均与结局显著相关（p<0.001）。MSI 对有器官功能障碍标志物的女性预测产妇死亡具有良好的准确性（AUROC-0.838[95%CI 0.766-0.910]）。然而，在 25 个 NM 标准中，只有 17 个 NM 标准和 3 个系统功能障碍（心血管、呼吸和神经）与结局显著相关。
MSS 和 MSI 可作为评估 NM 患者严重程度和估计 NM 患者死亡概率的良好预后工具。由于并非所有 NM 参数都能同等预测产妇发病率的严重程度，因此在计算 MSS 时应根据 NM 参数和系统分别给予不同的评分，以进行更好的预后预测。
