Department of Obstetrics and Gynecology, Women's Wellness and Research Centre, Hamad Medical Corporation, Doha, Qatar.
Women's Wellness and Research Centre, Executive Director of Quality and Safety, Hamad Medical Corporation, Doha, Qatar.
BMC Pregnancy Childbirth. 2024 Jun 8;24(1):415. doi: 10.1186/s12884-024-06612-x.
The Obstetric Comorbidity Index (OBCMI) is an internationally validated scoring system for maternal risk factors intended to reliably predict the occurrence of severe maternal morbidity (SMM). This retrospective cohort study applied the OBCMI to pregnant women in Qatar to validate its performance in predicting SMM and cumulative fetal morbidity.
Data from 1000 women who delivered in July 2021 in a large tertiary centre was extracted from medical records. The OBCMI index included maternal demographics, pre-existing comorbidities, and various current pregnancy risk factors such as hypertension, including preeclampsia, intrauterine fetal death, prolonged rupture of membranes and unbooked pregnancies. SMM was based on the ACOG consensus definition, and the cumulative fetal morbidity (CFM) included fetal distress in labour, low APGAR and umbilical artery (UA) pH, admission to neonatal intensive care (NICU), and hypoxic-ischemic encephalopathy (HIE). A c-statistic or area under curve (AUC) was calculated to determine the ability of OBCMI to predict SMM and CFM.
The median OBCMI score for the cohort was 1 (interquartile range- 0 to 2); 50% of women scored 0, while 85% (n = 842) had a score ranging from 0 to 2. Ten women (1%) scored ≥ 7; the highest score was 10. The incidence of SMM was 13%. According to the modified scoring system, the mean OBCMI score in those who developed SMM was 2.18 (± 2.20) compared to a mean of 1.04 (± 1.40) in those who did not (median 1, IQR:1-3 versus median 0, IQR: 0-2; p < 0.001). The incidence of CFM was 11.3%. The incidence of low APGAR score, HIE and NICU admission was nearly 1 in 1000. Around 5% of the babies had fetal distress in labour and low UA pH. For every 1 unit increase in OBCMI score, the odds of SMM increased by 44% (OR 1.44 95% CI 1.30-1.59; p < 0.001; AUC 0.66), and CFM increased by 28% (OR 1.28 95% CI 1.15-1.42; p < 0.001; AUC 0.61). A cut-off score of 4 had a high specificity (> 90%); 1 in 4 and 1 in 6 women with OBCMI score ≥ 4 developed SMM and CFM, respectively.
The OBCMI performed moderately well in predicting SMM in pregnant women of Qatar and can be effectively used as a risk assessment tool to red-flag high-risk cases so that appropriate and timely multidisciplinary care can be initiated to reduce SMM and maternal mortality. The index is also helpful in predicting fetal morbidity; however, further prospective studies are required to validate OBCMI for CFM.
产科合并症指数（OBCMI）是一种国际上经过验证的用于预测严重产妇发病率（SMM）的产妇风险因素评分系统。本回顾性队列研究将 OBCMI 应用于卡塔尔的孕妇，以验证其在预测 SMM 和累积胎儿发病率方面的性能。
从一家大型三级中心 2021 年 7 月分娩的 1000 名妇女的病历中提取数据。OBCMI 指数包括产妇人口统计学、既往合并症和各种当前妊娠风险因素，如高血压，包括子痫前期、胎儿宫内死亡、胎膜延长破裂和未预约妊娠。SMM 基于 ACOG 共识定义，累积胎儿发病率（CFM）包括分娩时胎儿窘迫、低 Apgar 评分和脐动脉（UA）pH 值、新生儿重症监护病房（NICU）入院和缺氧缺血性脑病（HIE）。计算 c 统计量或曲线下面积（AUC）以确定 OBCMI 预测 SMM 和 CFM 的能力。
队列的中位数 OBCMI 评分为 1（四分位距-0 至 2）；50%的女性评分为 0，而 85%（n=842）的评分为 0 至 2。有 10 名女性（1%）的评分≥7；最高评分为 10。SMM 的发病率为 13%。根据改良评分系统，发生 SMM 的患者的平均 OBCMI 评分为 2.18（±2.20），而未发生 SMM 的患者的平均评分为 1.04（±1.40）（中位数 1，IQR：1-3 与中位数 0，IQR：0-2；p<0.001）。CFM 的发病率为 11.3%。低 Apgar 评分、HIE 和 NICU 入院的发病率接近每 1000 例 1 例。约有 5%的婴儿在分娩时出现胎儿窘迫和低 UA pH 值。OBCMI 评分每增加 1 个单位，SMM 的发生几率增加 44%（OR 1.44，95%CI 1.30-1.59；p<0.001；AUC 0.66），CFM 增加 28%（OR 1.28，95%CI 1.15-1.42；p<0.001；AUC 0.61）。4 分的截断值具有高特异性（>90%）；1 名 OBCMI 评分≥4 的妇女中有 4 分之 1 和 6 分之 1 发生 SMM 和 CFM。
OBCMI 在预测卡塔尔孕妇的 SMM 方面表现良好，可以有效地用作风险评估工具，以标记高危病例，以便及时提供适当的多学科护理，从而降低 SMM 和产妇死亡率。该指数还有助于预测胎儿发病率；然而，需要进一步的前瞻性研究来验证 OBCMI 对 CFM 的预测能力。
