Prediction of severe adverse maternal outcome in women admitted in obstetric ward using physiological and biochemical parameters

Reena Rani, Sunita Bai Meena, C. P. Yadav, Deepti Goswami, Reva Tripathi, Asmita M. Rathore


Background: To study physiological and biochemical parameters to predict serious adverse maternal outcomes and to develop risk score using above parameters.

Methods: This prospective study was conducted in 500 high risk pregnant women attending tertiary care teaching hospital. We noted physiological and biochemical parameters as soon as they were available .The primary outcome measures was “severe adverse maternal outcome(SAMO)” in form of one or more among  mortality, near miss morbidity and ICU admissions.

Results: Out-off 500 women, severe adverse maternal outcomes were seen in 158 (31.6%) women. Most common cause of near miss maternal morbidity was hypertensive disease of pregnancy (62.7%) followed by major obstetric hemorrhage (18.9%). There were 33(6.6%) ICU admission, 23 (4.6%) maternal death and 153 (30.6%) near miss maternal morbidity. The most common cause of maternal death in our study was obstetric hemorrhage. The significant variables after multivariate analysis [temp, pulse, urine protein] were used  to devise a Maternal early warning score (MEWS) based on physiological parameters at score value of  ≥1/6 was found to have  sensitivity of 70% and specificity of 82% in predicting SAMO with AUROC of 0.76. The significant laboratory parameters after multivariate analysis were blood urea, serum creatinine, serum bilirubin and liver enzymes. The obstetric risk score (Maternal risk prediction score MRPS) which incorporated of these laboratory parameters in addition to physiological parameters has sensitivity of 82% and specificity of 75% with AUROC 0.79 value ≥ 2/18.

Conclusions: The addition of laboratotory parameters to physiological variables improves performance of risk score to predict SAMO.


High risk pregnancy, Maternal mortality, Near miss morbidity

Full Text:



Royal college of physicians. National Early warning score (NEWS): Standardizing the Assessment of acute illness severity in the NHS. Report of a working party. London: RCP, 2O12 .Available from (Last assessed on 25th November 2013).

Carle C, Alexander P, Columb M, Jpohal J. Design and internal validation of an obstetric early warning score: secondary analysis of the intensive care National Audit and research centre case Mix programme database. Anaesthesia. 2013;68:354-67.

Swanton RDJ, Al-Rawai S, Wee MYK. A national survey of obstetric early warning system in UK. Int J Obst Anesth. 2009;18:253-7.

All Wales Consensus paper 2012. Available at; (Last assessed on 25th November 2013).

Beane A, De Silva AP, De Silva N. ‘Evaluation of feasibility and performance of early warning scores to identify patients at risk of adverse outcomes in a low-middle income setting’. BMJ open. 2018;e019387.

Perera YS, Ranasinghe P, Adikari AMMC, Welivita WDTS, Perera WME, Wijesundara WMDR, et al. The value of the modified early warning score and biochemical parameters as predictors of patient outcome in acute medical admissions: A prospective study. Acute Med. 2011;10:126-32.

Milman N, Bergholt T, Byg KE. Reference intervals for hematological variables during normal pregnancy and postpartum in 434 healthy Danish women. Eur J Haematol. 2007;79:39.

Liu XH, Jiang YM, Shi H. Prospective, sequential, longitudinal study of coagulation changes during pregnancy in Chinese women. Int J Gynaecol Obstet. 2009;105(3):240.

Bacq Y, Zarka O, Brechot JF. Liver function tests in normal pregnancy: A prospective study of 102 pregnant women and 102 matched controls. Hepatology. 1996;23:1030.

Larsson A, Palm M, Hansson LO. Reference values for clinical chemistry tests during normal pregnancy. BJOG. 2008;115:874.

Brace V, Penney G, Hall M. Quantifying severe maternal morbidity: a Scottish population study. BJOG. 2004;111:481-4.

Singh S, McGlennan A, England A, Simons R. A Validation study of the CEMACH recommended MEOWS. Anesthesia. 2012;67:12-8.

Carle C, Pohal J, Columb M, Alexander. ‘Design and internal validation of obstetric early warning score: secondary analysis of intensive care National Audit and research centre case mix programme database.’ Anesthesia. 2013;68, 354-67.

O’Sullivan E, Callely E, O’Riordan D, Bennett K, Silke B. Predicting outcomes in emergency medical admissions - role of laboratory data and co-morbidity. Acute Medicine. 2012;11(2):59.

Romero-Ortuno R, Silke B. Use of a laboratory only score system to define trajectories andoutcomes of older people admitted to the acute hospital as medical emergencies. Geriatr Gerontol Int. 2012. doi: 10.1111/j.1447-0594.2012.00917.x.

Loekito E, Bailey J, Bellomo R. Common laboratory tests predict imminent death in ward patients. Resuscitation. 2013;84:280-5.

Loekito E, Bailey J, Bellomo R. Common laboratory tests predict imminent medical emergency team calls, intensive care unit admission or death in emergency department patients. Emergency Medicine Australasia. 2013;25:132-9.

Saravanakumar K. High dependency care in an obstetric setting in UK Anesthesia. Anesthesia. 2008;63(10):1081-6.