Role of Sepsis in Obstetric Score (SOS) to identify severe sepsis in pregnant women requiring ICU admission: A prospective observational study

Abstract

Introduction: Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Obstetric sepsis is a significant contributor to maternal and perinatal morbidity and mortality, especially in low-income countries. Several scoring systems can help in identifying sepsis and its severity; however, their application in the obstetric population is not well-defined because of the altered physiology of pregnancy. The Sepsis in Obstetrics Score (SOS) is designed specifically for the obstetric population to identify the likelihood of the need for critical care admission for the obstetric population presenting with signs of sepsis. Aim: To determine whether the SOS can be used to identify the severity of sepsis. Materials and Methods: This was a prospective observational time-bound study conducted at Gandhi Hospital, Secunderabad, Hyderabad, Telangana, India over six months from February 2023 to July 2023 on 100 subjects that included pregnant women, postpartum women within six weeks, and postabortal women within two weeks of abortion with suspected obstetric sepsis presenting to Gandhi Hospital. SOS score was calculated for all study participants and grouped into scores of <6 and ≥6. Organ failure was assessed. SOS score was associated with culture positivity, organ involvement, need for critical care support, and the severity of sepsis. Data were analysed using Statistical Packages for Social Sciences (SPSS) software, and appropriate statistical tests were applied; the p-value for significance was set at 0.05. Results: The mean age of the study population was 25.48±5.13 years. Out of 100 women with obstetric sepsis, 50% had severe sepsis, graded by the presence of organ failure. When the cut-off score was considered as 6, SOS score had a sensitivity of 64% and specificity of 84%, a Positive Predictive Value (PPV) of 80.0%, a Negative Predictive Value (NPV) of 70.0%, and a diagnostic accuracy of 74.0% to detecting severe sepsis. Conclusion: The findings emphasised the utility of the SOS score as a valuable tool for assessing the severity of illness, predicting outcomes, and guiding clinical management.

Keywords

• intensive care unit
• organ failure
• pregnancy-associated sepsis
• sepsis scores