A comorbidity-based screening tool to predict severe maternal morbidity at the time of delivery
The obstetric comorbidity index summarizes the burden of maternal comorbidities into a single number and holds promise as a maternal risk-assessment tool. The aim of this study was to assess the clinical performance of this comorbidity-based screening tool to accurately identify women on labor and d...
Gespeichert in:
| Veröffentlicht in: | American journal of obstetrics and gynecology 2019-09, Vol.221 (3), p.271.e1-271.e10 |
|---|---|
| Hauptverfasser: | , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 271.e10 |
|---|---|
| container_issue | 3 |
| container_start_page | 271.e1 |
| container_title | American journal of obstetrics and gynecology |
| container_volume | 221 |
| creator | Easter, Sarah Rae Bateman, Brian T. Sweeney, Valerie Horton Manganaro, Karen Lassey, Sarah C. Gagne, Joshua J. Robinson, Julian N. |
| description | The obstetric comorbidity index summarizes the burden of maternal comorbidities into a single number and holds promise as a maternal risk-assessment tool.
The aim of this study was to assess the clinical performance of this comorbidity-based screening tool to accurately identify women on labor and delivery who are at risk of severe maternal morbidity on labor and delivery in real time.
All patients with pregnancies ≥23 weeks gestation presenting to labor and delivery at a single tertiary-care center from February through July 2018 were included in the study. The patient’s primary labor and delivery nurse assessed patient comorbidities and calculated the patient’s obstetric comorbidity index. The score was recalculated at each 12-hour shift change. A multidisciplinary panel of clinicians determined whether patients experienced severe maternal morbidity based on the American College of Obstetrics and Gynecology and Society for Maternal-Fetal Medicine consensus definition, blinded to the patient’s obstetric comorbidity index score. We analyzed the association between the obstetric comorbidity index score and the occurrence of severe maternal morbidity.
The study included 2828 women, of whom 1.73% experience severe maternal morbidity (n=49). The obstetric comorbidity index ranged from 0–15 for women in the study cohort, with a median obstetric comorbidity index of 1 (interquartile range, 0–3). The median obstetric comorbidity index score for women who experienced the severe maternal morbidity was 5 (interquartile range, 3–7) compared with a median of 1 (interquartile range, 0–3) for those without severe maternal morbidity (P |
| doi_str_mv | 10.1016/j.ajog.2019.06.025 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2246234229</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0002937819307896</els_id><sourcerecordid>2246234229</sourcerecordid><originalsourceid>FETCH-LOGICAL-c356t-8d42d370d767b83b9826e66ca5e3de7395357b2aba87112d9ba087807ee74303</originalsourceid><addsrcrecordid>eNp9kE1LAzEURYMoWqt_wIVk6WbGfMwkGXAj4hcIbtyHTPJaU2YmNUmF_ntTWl26eXmBcy-8g9AVJTUlVNyuarMKy5oR2tVE1IS1R2hGSScroYQ6RjNCCKs6LtUZOk9ptfuyjp2iM07L0jA5Q_oe2zCG2Hvn87bqTQKHk40Ak5-WOIcwlIHXEZy3GSf4hgh4NBniZAb8l8Qm4_wJOPsRcFhgB4Mv6PYCnSzMkODy8M7Rx9Pjx8NL9fb-_Ppw_1ZZ3opcKdcwxyVxUshe8b5TTIAQ1rTAHUjetbyVPTO9UZJS5rreECUVkQCy4YTP0c2-dh3D1wZS1qNPFobBTBA2STPWCMabcnVB2R61MaQUYaHX0Y8mbjUleudVr_TOq9551UTo4rWErg_9m34E9xf5FVmAuz0A5chvD1En62GyRVsEm7UL_r_-H_F7iXs</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2246234229</pqid></control><display><type>article</type><title>A comorbidity-based screening tool to predict severe maternal morbidity at the time of delivery</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Easter, Sarah Rae ; Bateman, Brian T. ; Sweeney, Valerie Horton ; Manganaro, Karen ; Lassey, Sarah C. ; Gagne, Joshua J. ; Robinson, Julian N.</creator><creatorcontrib>Easter, Sarah Rae ; Bateman, Brian T. ; Sweeney, Valerie Horton ; Manganaro, Karen ; Lassey, Sarah C. ; Gagne, Joshua J. ; Robinson, Julian N.</creatorcontrib><description>The obstetric comorbidity index summarizes the burden of maternal comorbidities into a single number and holds promise as a maternal risk-assessment tool.
The aim of this study was to assess the clinical performance of this comorbidity-based screening tool to accurately identify women on labor and delivery who are at risk of severe maternal morbidity on labor and delivery in real time.
All patients with pregnancies ≥23 weeks gestation presenting to labor and delivery at a single tertiary-care center from February through July 2018 were included in the study. The patient’s primary labor and delivery nurse assessed patient comorbidities and calculated the patient’s obstetric comorbidity index. The score was recalculated at each 12-hour shift change. A multidisciplinary panel of clinicians determined whether patients experienced severe maternal morbidity based on the American College of Obstetrics and Gynecology and Society for Maternal-Fetal Medicine consensus definition, blinded to the patient’s obstetric comorbidity index score. We analyzed the association between the obstetric comorbidity index score and the occurrence of severe maternal morbidity.
The study included 2828 women, of whom 1.73% experience severe maternal morbidity (n=49). The obstetric comorbidity index ranged from 0–15 for women in the study cohort, with a median obstetric comorbidity index of 1 (interquartile range, 0–3). The median obstetric comorbidity index score for women who experienced the severe maternal morbidity was 5 (interquartile range, 3–7) compared with a median of 1 (interquartile range, 0–3) for those without severe maternal morbidity (P<.01). The frequency of severe maternal morbidity increased from 0.41% for those with a score of 0 to 18.75% for those with a score ≥9. For every 1-point increase in the score, patients experienced a 1.55 increase in odds of severe maternal morbidity (95% confidence interval, 1.42–1.70). The c-statistic for the obstetric comorbidity index score was 0.83 (95% confidence interval, 0.76–0.89), which indicated strong discrimination.
The obstetric comorbidity index can prospectively identify women at risk of severe maternal morbidity in a clinical setting. A particular strength of the obstetric comorbidity index is its ability to integrate multiple compounding comorbidities and highlight the cumulative risk that is associated with the patients’ conditions. Routine clinical use of the obstetric comorbidity index has the potential to identify at-risk women whose condition warrants increased surveillance and targeted care to prevent adverse maternal outcomes.</description><identifier>ISSN: 0002-9378</identifier><identifier>EISSN: 1097-6868</identifier><identifier>DOI: 10.1016/j.ajog.2019.06.025</identifier><identifier>PMID: 31229427</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Boston - epidemiology ; Comorbidity ; Delivery, Obstetric ; Female ; hemorrhage ; Humans ; maternal death ; Obstetric Labor Complications - diagnosis ; Obstetric Labor Complications - epidemiology ; Obstetric Labor Complications - etiology ; Obstetric Labor Complications - prevention & control ; Pregnancy ; Pregnancy Complications - diagnosis ; Pregnancy Complications - epidemiology ; Prospective Studies ; Risk Assessment ; screening ; severe maternal morbidity ; Severity of Illness Index</subject><ispartof>American journal of obstetrics and gynecology, 2019-09, Vol.221 (3), p.271.e1-271.e10</ispartof><rights>2019 Elsevier Inc.</rights><rights>Copyright © 2019 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c356t-8d42d370d767b83b9826e66ca5e3de7395357b2aba87112d9ba087807ee74303</citedby><cites>FETCH-LOGICAL-c356t-8d42d370d767b83b9826e66ca5e3de7395357b2aba87112d9ba087807ee74303</cites><orcidid>0000-0002-0150-3537</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002937819307896$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,65309</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31229427$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Easter, Sarah Rae</creatorcontrib><creatorcontrib>Bateman, Brian T.</creatorcontrib><creatorcontrib>Sweeney, Valerie Horton</creatorcontrib><creatorcontrib>Manganaro, Karen</creatorcontrib><creatorcontrib>Lassey, Sarah C.</creatorcontrib><creatorcontrib>Gagne, Joshua J.</creatorcontrib><creatorcontrib>Robinson, Julian N.</creatorcontrib><title>A comorbidity-based screening tool to predict severe maternal morbidity at the time of delivery</title><title>American journal of obstetrics and gynecology</title><addtitle>Am J Obstet Gynecol</addtitle><description>The obstetric comorbidity index summarizes the burden of maternal comorbidities into a single number and holds promise as a maternal risk-assessment tool.
The aim of this study was to assess the clinical performance of this comorbidity-based screening tool to accurately identify women on labor and delivery who are at risk of severe maternal morbidity on labor and delivery in real time.
All patients with pregnancies ≥23 weeks gestation presenting to labor and delivery at a single tertiary-care center from February through July 2018 were included in the study. The patient’s primary labor and delivery nurse assessed patient comorbidities and calculated the patient’s obstetric comorbidity index. The score was recalculated at each 12-hour shift change. A multidisciplinary panel of clinicians determined whether patients experienced severe maternal morbidity based on the American College of Obstetrics and Gynecology and Society for Maternal-Fetal Medicine consensus definition, blinded to the patient’s obstetric comorbidity index score. We analyzed the association between the obstetric comorbidity index score and the occurrence of severe maternal morbidity.
The study included 2828 women, of whom 1.73% experience severe maternal morbidity (n=49). The obstetric comorbidity index ranged from 0–15 for women in the study cohort, with a median obstetric comorbidity index of 1 (interquartile range, 0–3). The median obstetric comorbidity index score for women who experienced the severe maternal morbidity was 5 (interquartile range, 3–7) compared with a median of 1 (interquartile range, 0–3) for those without severe maternal morbidity (P<.01). The frequency of severe maternal morbidity increased from 0.41% for those with a score of 0 to 18.75% for those with a score ≥9. For every 1-point increase in the score, patients experienced a 1.55 increase in odds of severe maternal morbidity (95% confidence interval, 1.42–1.70). The c-statistic for the obstetric comorbidity index score was 0.83 (95% confidence interval, 0.76–0.89), which indicated strong discrimination.
The obstetric comorbidity index can prospectively identify women at risk of severe maternal morbidity in a clinical setting. A particular strength of the obstetric comorbidity index is its ability to integrate multiple compounding comorbidities and highlight the cumulative risk that is associated with the patients’ conditions. Routine clinical use of the obstetric comorbidity index has the potential to identify at-risk women whose condition warrants increased surveillance and targeted care to prevent adverse maternal outcomes.</description><subject>Adult</subject><subject>Boston - epidemiology</subject><subject>Comorbidity</subject><subject>Delivery, Obstetric</subject><subject>Female</subject><subject>hemorrhage</subject><subject>Humans</subject><subject>maternal death</subject><subject>Obstetric Labor Complications - diagnosis</subject><subject>Obstetric Labor Complications - epidemiology</subject><subject>Obstetric Labor Complications - etiology</subject><subject>Obstetric Labor Complications - prevention & control</subject><subject>Pregnancy</subject><subject>Pregnancy Complications - diagnosis</subject><subject>Pregnancy Complications - epidemiology</subject><subject>Prospective Studies</subject><subject>Risk Assessment</subject><subject>screening</subject><subject>severe maternal morbidity</subject><subject>Severity of Illness Index</subject><issn>0002-9378</issn><issn>1097-6868</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE1LAzEURYMoWqt_wIVk6WbGfMwkGXAj4hcIbtyHTPJaU2YmNUmF_ntTWl26eXmBcy-8g9AVJTUlVNyuarMKy5oR2tVE1IS1R2hGSScroYQ6RjNCCKs6LtUZOk9ptfuyjp2iM07L0jA5Q_oe2zCG2Hvn87bqTQKHk40Ak5-WOIcwlIHXEZy3GSf4hgh4NBniZAb8l8Qm4_wJOPsRcFhgB4Mv6PYCnSzMkODy8M7Rx9Pjx8NL9fb-_Ppw_1ZZ3opcKdcwxyVxUshe8b5TTIAQ1rTAHUjetbyVPTO9UZJS5rreECUVkQCy4YTP0c2-dh3D1wZS1qNPFobBTBA2STPWCMabcnVB2R61MaQUYaHX0Y8mbjUleudVr_TOq9551UTo4rWErg_9m34E9xf5FVmAuz0A5chvD1En62GyRVsEm7UL_r_-H_F7iXs</recordid><startdate>201909</startdate><enddate>201909</enddate><creator>Easter, Sarah Rae</creator><creator>Bateman, Brian T.</creator><creator>Sweeney, Valerie Horton</creator><creator>Manganaro, Karen</creator><creator>Lassey, Sarah C.</creator><creator>Gagne, Joshua J.</creator><creator>Robinson, Julian N.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-0150-3537</orcidid></search><sort><creationdate>201909</creationdate><title>A comorbidity-based screening tool to predict severe maternal morbidity at the time of delivery</title><author>Easter, Sarah Rae ; Bateman, Brian T. ; Sweeney, Valerie Horton ; Manganaro, Karen ; Lassey, Sarah C. ; Gagne, Joshua J. ; Robinson, Julian N.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c356t-8d42d370d767b83b9826e66ca5e3de7395357b2aba87112d9ba087807ee74303</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adult</topic><topic>Boston - epidemiology</topic><topic>Comorbidity</topic><topic>Delivery, Obstetric</topic><topic>Female</topic><topic>hemorrhage</topic><topic>Humans</topic><topic>maternal death</topic><topic>Obstetric Labor Complications - diagnosis</topic><topic>Obstetric Labor Complications - epidemiology</topic><topic>Obstetric Labor Complications - etiology</topic><topic>Obstetric Labor Complications - prevention & control</topic><topic>Pregnancy</topic><topic>Pregnancy Complications - diagnosis</topic><topic>Pregnancy Complications - epidemiology</topic><topic>Prospective Studies</topic><topic>Risk Assessment</topic><topic>screening</topic><topic>severe maternal morbidity</topic><topic>Severity of Illness Index</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Easter, Sarah Rae</creatorcontrib><creatorcontrib>Bateman, Brian T.</creatorcontrib><creatorcontrib>Sweeney, Valerie Horton</creatorcontrib><creatorcontrib>Manganaro, Karen</creatorcontrib><creatorcontrib>Lassey, Sarah C.</creatorcontrib><creatorcontrib>Gagne, Joshua J.</creatorcontrib><creatorcontrib>Robinson, Julian N.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>American journal of obstetrics and gynecology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Easter, Sarah Rae</au><au>Bateman, Brian T.</au><au>Sweeney, Valerie Horton</au><au>Manganaro, Karen</au><au>Lassey, Sarah C.</au><au>Gagne, Joshua J.</au><au>Robinson, Julian N.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A comorbidity-based screening tool to predict severe maternal morbidity at the time of delivery</atitle><jtitle>American journal of obstetrics and gynecology</jtitle><addtitle>Am J Obstet Gynecol</addtitle><date>2019-09</date><risdate>2019</risdate><volume>221</volume><issue>3</issue><spage>271.e1</spage><epage>271.e10</epage><pages>271.e1-271.e10</pages><issn>0002-9378</issn><eissn>1097-6868</eissn><abstract>The obstetric comorbidity index summarizes the burden of maternal comorbidities into a single number and holds promise as a maternal risk-assessment tool.
The aim of this study was to assess the clinical performance of this comorbidity-based screening tool to accurately identify women on labor and delivery who are at risk of severe maternal morbidity on labor and delivery in real time.
All patients with pregnancies ≥23 weeks gestation presenting to labor and delivery at a single tertiary-care center from February through July 2018 were included in the study. The patient’s primary labor and delivery nurse assessed patient comorbidities and calculated the patient’s obstetric comorbidity index. The score was recalculated at each 12-hour shift change. A multidisciplinary panel of clinicians determined whether patients experienced severe maternal morbidity based on the American College of Obstetrics and Gynecology and Society for Maternal-Fetal Medicine consensus definition, blinded to the patient’s obstetric comorbidity index score. We analyzed the association between the obstetric comorbidity index score and the occurrence of severe maternal morbidity.
The study included 2828 women, of whom 1.73% experience severe maternal morbidity (n=49). The obstetric comorbidity index ranged from 0–15 for women in the study cohort, with a median obstetric comorbidity index of 1 (interquartile range, 0–3). The median obstetric comorbidity index score for women who experienced the severe maternal morbidity was 5 (interquartile range, 3–7) compared with a median of 1 (interquartile range, 0–3) for those without severe maternal morbidity (P<.01). The frequency of severe maternal morbidity increased from 0.41% for those with a score of 0 to 18.75% for those with a score ≥9. For every 1-point increase in the score, patients experienced a 1.55 increase in odds of severe maternal morbidity (95% confidence interval, 1.42–1.70). The c-statistic for the obstetric comorbidity index score was 0.83 (95% confidence interval, 0.76–0.89), which indicated strong discrimination.
The obstetric comorbidity index can prospectively identify women at risk of severe maternal morbidity in a clinical setting. A particular strength of the obstetric comorbidity index is its ability to integrate multiple compounding comorbidities and highlight the cumulative risk that is associated with the patients’ conditions. Routine clinical use of the obstetric comorbidity index has the potential to identify at-risk women whose condition warrants increased surveillance and targeted care to prevent adverse maternal outcomes.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>31229427</pmid><doi>10.1016/j.ajog.2019.06.025</doi><orcidid>https://orcid.org/0000-0002-0150-3537</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0002-9378 |
| ispartof | American journal of obstetrics and gynecology, 2019-09, Vol.221 (3), p.271.e1-271.e10 |
| issn | 0002-9378 1097-6868 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2246234229 |
| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Adult Boston - epidemiology Comorbidity Delivery, Obstetric Female hemorrhage Humans maternal death Obstetric Labor Complications - diagnosis Obstetric Labor Complications - epidemiology Obstetric Labor Complications - etiology Obstetric Labor Complications - prevention & control Pregnancy Pregnancy Complications - diagnosis Pregnancy Complications - epidemiology Prospective Studies Risk Assessment screening severe maternal morbidity Severity of Illness Index |
| title | A comorbidity-based screening tool to predict severe maternal morbidity at the time of delivery |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-25T18%3A54%3A31IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=A%20comorbidity-based%20screening%20tool%20to%20predict%20severe%20maternal%20morbidity%20at%20the%20time%20of%20delivery&rft.jtitle=American%20journal%20of%20obstetrics%20and%20gynecology&rft.au=Easter,%20Sarah%20Rae&rft.date=2019-09&rft.volume=221&rft.issue=3&rft.spage=271.e1&rft.epage=271.e10&rft.pages=271.e1-271.e10&rft.issn=0002-9378&rft.eissn=1097-6868&rft_id=info:doi/10.1016/j.ajog.2019.06.025&rft_dat=%3Cproquest_cross%3E2246234229%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2246234229&rft_id=info:pmid/31229427&rft_els_id=S0002937819307896&rfr_iscdi=true |