Development and validation of saving mothers score: A comprehensive scoring system for early identification of sick mothers

• Main Authors: Kousalya Chakravarthy, Sunil T Pandya, Praveen K Nirmalan
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2018-01-01
• Series: Journal of Obstetric Anaesthesia and Critical Care
• Subjects: High-risk pregnancy; maternal mortality; sensitivity; specificity; trigger
• Online Access: http://www.joacc.com/article.asp?issn=2249-4472;year=2018;volume=8;issue=2;spage=83;epage=89;aulast=Chakravarthy

Context: Early identification of high-risk parturient and maternal physiological deterioration may reduce maternal morbidity and mortality. Aims: This study aimed to develop a comprehensive scoring system 'Saving Mothers Score' (SMS) to identify the sick mothers and validate SMS against the existing Modified Early Obstetric Warning System (MEOWS). Settings and Design: The SMS was developed through a formative research, item pool generation, content and construct validity. Methodology: Thirty-three (33) items were identified and pooled into three parameters pregnancy-related risk factors, physiological variables and biochemical tests. Each item was given a colour coding and a score. The trigger and score of SMS was prospectively analysed in 120 obstetric in-patients. Statistical Analysis Used: Tests of diagnostic effectiveness and 95% confidence intervals (95% CI) around point estimates. Results: Forty six women triggered (38.33%; 95% CI: 29.96, 47.26) and 41 (81.93%, 95% CI: 77.54, 95.91) of these 46 women developed morbidity. The overall accuracy of SMS chart was similar for trigger [sensitivity 60.9%; specificity 98.6%, area under receiver operator characteristic curve (AUROC) 0.80] and scoring (sensitivity 56.1%; specificity 92.4%, AUROC 0.74) with positive predictive value (PPV) and negative predictive value (NPV) of 96.6% and 80.2%, respectively. The accuracy of SMS was comparable to MEOWS (sensitivity 54.6%, specificity 97.8%, PPV 92.5% and NPV 79.9%). Conclusions: The diagnostic effectiveness of SMS was comparable to MEOWS. SMS may be used as a screening test to identify a sick mother. SMS can predict morbidity, help in triage and early intervention or timely referral to a higher centre.