Prediction of morbidity in antenatal and postnatal women using sepsis in obstetrics score

Background: Maternal deaths predominate (99%) in low- and middle-income nations. Postpartum haemorrhage, pre-eclampsia, and puerperal sepsis are identified as the three primary factors contributing to maternal mortality in the aforementioned regions. Various diagnostic criteria are employed to identify sepsis, with one of the frequently utilised criteria being the systematic inflammatory response syndrome (SIRS). Nevertheless, these criteria necessitate laboratory investigations that may not be viable in settings with limited resources. The objective of this study was to devise a model that utilises clinical indicators and risk factors to promptly detect sepsis in postpartum females.
Material and Methods: This is an observational study conducted in the Department of Obstetrics and Gynaecology, Gandhi Medical College, Bhopal, after institutional ethical committee approval, from January 2021 to June 2022. All antenatal and postnatal women (within 42 days of delivery) reporting to the emergency department in the Department of Obstetrics and Gynaecology, Gandhi Medical College, Bhopal were included. All antenatal and postnatal cases meeting 2 or more SIRS criteria at admission during the study period and willing to give written consent were included in the study. Patients who did not meet the SIRS criteria were excluded.
Results: Out of the total included patients, 450 (1.26%) was the total burden of sepsis. Sepsis among antenatal cases was 217 out of 18085, giving a burden of 1.19%. Sepsis among puerperal cases was 233 out of 17354, giving a burden of 1.34%. Unbooked cases had a higher sepsis score of > 6. A significant association was found between maternal outcome and SOS scores. 22 cases were transferred out to other departments (for needed medical interventions) and mortalities were seen in 6 mothers in the present study. Among the mothers who died, 5 had SOS scores of more than 6. Fetal outcome: In the present study, 361 were live births, 29 were stillbirths, and 9 were IUFD.
Conclusion: Sepsis now causes the most preventable maternal deaths worldwide. Prioritising maternal sepsis and septic shock tool development and validation. Early sepsis screening of high-risk obstetric patients uses the SOS score. Pregnancy-associated sepsis and complications have few emergency room scoring systems. This study confirmed the SOS score’s ability to distinguish severe pregnancy-associated sepsis. It may help prioritise and distribute critical care beds in low-resource countries due to high sepsis-related maternal morbidity and mortality. We strongly recommend further validation and demonstration of SOS efficacy in obstetric sepsis.