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Grand Rounds

Maternal ICU Admission: A Predictive Model

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BACKGROUND AND PURPOSE:

  • Over the past 20 years in the US, maternal morbidity has increased by approximately 200%
  • Rossi et al. (Obstetrics & Gynecology, 2019) evaluated risk factors associated with maternal ICU admission and incorporated these features into a multivariable predictive model

METHODS:

  • Population-based cohort study (2012 to 2016)
  • Participants
    • All live births | Gestational age 20w0d to 44w6d
  • Risk factors
    • Maternal demographics (e.g., age, race, prenatal care etc.)
    • Co-morbidities
    • Pregnancy specific conditions (e.g., GDM, preeclampsia etc.)
    • Other Ob characteristics (e.g., previous C/S, route of delivery etc.)
  • Data analysis
    • Predictive model: Internal validation followed by external validation on a separate live birth cohort (2006–2011; n=856,255)
  • Primary outcome
    • Prenatal factors associated with increased risk of maternal ICU admission

RESULTS:

  • 18,745,615 live births | 0.15% (27,602) of mothers admitted to the NICU
  • Most significant risk factors included
    • Scheduled cesarean | Gestational age (decreasing) | Preeclampsia | Induction of labor | Chronic hypertension | Maternal Age | Race
    • BMI was not associated with ICU admission as a continuous variable | BMI ≥50 was ‘moderately’ associated with ICU admission
  • Fourteen variables were selected for inclusion in the predictive model for maternal ICU admission
    • Area under the curve (AUC) of 0.81 (95% CI 0.79 to 0.81)
    • Indicated women who were at 30-fold risk for ICU admission
  • Predicted minimal and maximal risk for ICU admission ranged from 0–25%
  • External validation matched up with internal results
    • AUC of 0.83 (95% CI, 0.82 to 0.84)
  • Adjusting up to high cut point of ≥5.0% risk for ICU admission only achieved a positive predictive value (PPV) of 4.0%

CONCLUSION:

  • The predictive model can help to better understand effect of risk factors on ICU admission risk
  • However, PPV was low due to underlying low a priori risk and therefore the authors caution against the use of their model
  • It is possible that the algorithm can be clinically useful in a high risk setting, which would improve PPVs

Learn More – Primary Sources:

Predictive Model of Factors Associated With Maternal Intensive Care Unit Admission

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Related ObG Topics:

Maternal Near-Misses: An Investigation of Incidence and Causes
Pregnancy-Related Deaths in the U.S.: How Many are Preventable?
A New Predictive Model for Successful Induction of Labor

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