Leonard et al reported comorbidity scores for pregnant women. One score predicts the risk for all-cause severe morbidity and mortality and a second score predicts non-transfusion-requiring complications. The authors are from Stanford University and the University of California Berkeley.
Patient selection: pregnant woman
Parameters:
(1) placenta accreta spectrum
(2) pulmonary hypertension
(3) chronic renal disease
(4) pre-existing bleeding disorder
(5) pre-existing cardiac disease
(6) HIV or AIDS
(7) placenta previa, complete or partial
(8) preeclampsia
(9) anemia, pre-existing
(10) twin or multiple pregnancy
(11) placental abruption
(12) preterm birth (< 37 weeks)
(13) gastrointestinal disease
(14) asthma, acute or >= moderate
(15) substance use disorder
(16) connective tissue or autoimmune disease
(17) chronic hypertension
(18) diabetes mellitus
(19) neuromuscular disease
(20) major mental health disorder
(21 thyrotoxicosis
(22) BMI >= 40 kg per sq m at delivery
(23) previous cesarean birth
(24) maternal age >= 35 years
|
Parameter |
Finding |
Points |
|
placenta accreta |
yes |
59 |
|
|
no |
0 |
|
pulmonary hypertension |
yes |
50 |
|
|
no |
0 |
|
chronic renal disease |
yes |
38 |
|
|
no |
0 |
|
pre-existing bleeding disorder |
yes |
34 |
|
|
no |
0 |
|
pre-existing cardiac disease |
yes |
31 |
|
|
no |
0 |
|
HIV or AIDS |
yes |
30 |
|
|
no |
0 |
|
placenta previa |
yes |
27 |
|
|
no |
0 |
|
preeclampsia |
severe features |
26 |
|
|
nonsevere |
11 |
|
|
gestational hypertension |
11 |
|
|
no |
0 |
|
anemia, pre-existing |
yes |
20 |
|
|
no |
0 |
|
twin or multiple pregnancy |
yes |
20 |
|
|
no |
0 |
|
placental abruption |
yes |
18 |
|
|
no |
0 |
|
preterm birth |
yes |
18 |
|
|
no |
0 |
|
gastrointestinal disease |
yes |
12 |
|
|
no |
0 |
|
asthma |
acute or moderate-severe |
11 |
|
|
mild |
0 |
|
|
no |
0 |
|
substance use disorder |
yes |
10 |
|
|
no |
0 |
|
connective tissue/autoimmune |
yes |
10 |
|
|
no |
0 |
|
chronic hypertension |
yes |
10 |
|
|
no |
0 |
|
diabetes mellitus |
pre-existing |
9 |
|
|
gestational |
1 |
|
|
absent |
0 |
|
neuromuscular disease |
yes |
9 |
|
|
no |
0 |
|
major mental health disorder |
yes |
7 |
|
|
no |
0 |
|
thyrotoxicosis |
yes |
6 |
|
|
no |
0 |
|
BMI at delivery |
>= 40 kg per sq m |
5 |
|
|
< 40 kg per sq m |
0 |
|
previous cesarean |
yes |
4 |
|
|
no |
0 |
|
maternal age |
>= 35 years |
2 |
|
|
< 35 years |
0 |
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 466
• The higher the score the greater the risk of a significant complication.
Performance:
• The area under the ROC curve is 0.78.
Specialty: Obstetrics & Gynecology
