Comparison of Modified Obstetric Early Warning Score (MOEWS) and Quick Sequential Organ Failure Assessment for Pregnancy (qSOFA-P) Score for prognostication of critically ill obstetric patients admitted to Intensive care unit in a tertiary care hospital in Northern India: A Prospective observational study

Pregnancy is associated with many physiological changes involving the cardiovascular, respiratory, renal, and haematological system; thus, interpretation of these scores is more challenging in the obstetric population. It has been seen that the use of these scores in obstetric patients often overpredicts mortality. Overestimation of mortality risk by these scores in obstetric patients likely relates to pregnancy-related physiological changes that are not included in mortality scores, demographic characteristics, and lack of comorbidities in this population, and the significant and unique improvement in mortality that follows specific interventions in pregnancy.

No national or international ‘Gold standard’ obstetric early warning scoring system exists. Maternal Early Obstetric Warning System (MEOWS) chart adopted from CEMACH 2003– 2005 report is based on the principle that abnormalities in physiological parameters precede critical illness. The ‘track and trigger’ of physiological parameters on this chart can aid in recognition of maternal morbidity at an early stage, ultimately halting the cascade of severe maternal morbidity and mortality.  The major advantage of this score is that it uses the triggers according to the physiological changes of pregnant women. Secondly, since the score is based only on clinical parameters and no laboratory values are required, it is easy to calculate and less time-consuming.11,12Pregnancy-specific modifications or "qSOFA-P" (respiratory rate [RR] ≥ 35 breaths/minute and systolic blood pressure [SBP] ≤ 85 mm Hg)  has been found to significantly improve prediction of severe maternal morbidity (AUC = 0.77, p < 0.001, sensitivity = 0.79, and specificity = 0.74).13 The aim of this study is to evaluate accuracy of MOEWS and qSOFA-P to predict mortality for obstetric patients admitted to ICU in a tertiary care hospital of North India.