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COVID-19 and Women’s Health

An Obstetric Warning Score for Pregnant COVID-19 Patients at Highest Risk for Respiratory Failure

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BACKGROUND AND PURPOSE:

  • Yao et al. (AJOG MFM, 2021) developed a pregnancy-specific early warning score to identify patients with positive SARS-CoV-2 infection at risk for clinical deterioration and requiring advanced respiratory support (ARS) based on initial clinical characteristics

METHODS:

  • Retrospective cohort study
  • Participants
    • Pregnant patients with SARS-CoV-2 infection (April 2020 to December 2020)
  • Study design
    • Prediction model derived from 50 patients with SARS-CoV-2 infection
    • The authors compared initial clinical characteristics between patients who required ARS and patients who were asymptomatic or had mild symptoms
    • Risk factors for ARS requirement used to create the Obstetric Warning Score (OWS)
    • OWS validated against a separate 30 patient test cohort
    • Receiver operator curve (ROC) was generated to evaluate OWSS against
      • The Early Warning Score (EWS)
      • The National Early Warning Score 2 (NEWS2)
      • The Maternal Early Warning Criteria (MEWC)

RESULTS:

  • 50 patients training cohort | 30 patients validation cohort
  • Women who required ARS were more likely to present with
    • Dyspnea (p < 0.001)
      • Required ARS: 100%
      • Asymptomatic and mild: 33.3%
    • Higher heart rate (p < 0.001)
      • Required ARS: 113.4 bpm
      • Asymptomatic and mild: 93 bpm
    • Higher respiratory rate (p < 0.001)
      • Required ARS: 23.5 bpm
      • Asymptomatic and mild: 17.7 bpm
    • Higher temperature (p = 0.004)
      • Required ARS: 99.1 °F
      • Asymptomatic and mild: 98.3 °F
    • Higher levels of C-Reactive Protein (CRP; p < 0.001)
      • Required ARS: 7.4 mg/dL
      • Asymptomatic and mild: 2.4 mg/dL
    • Chest x-ray findings consistent with pneumonia
      • Required ARS: 88.2% of patients
      • Asymptomatic and mild: 20.0% of patients
  • Total points ≥3 used to predict high risk for clinical deterioration
    • 1 point each for the following: HR > 100 bpm | Temperature > 99.0 °F | CRP >2.0 mg/dL | Respiratory rate ≥20 and <24 bpm | Complaints of dyspnea | Positive chest x-ray for pneumonia
    • 2 points: Respiratory rate >24 bpm
  • Area under the curve for OWS was 0.97 compared to
    • EWS: 0.72
    • NEWS2: 0.92
    • MEWC: 0.85
  • An OWS score ≥3 was predictive of ARS requirement with
    • Sensitivity: 100%
    • Specificity: 64%
    • Positive predictive value: 36%

CONCLUSION:

  • The OWS score was able to identify pregnant patients with SARS-CoV-2 infection who are most at risk of requiring advance respiratory care
  • The authors state

It is our hope that the OWS prediction model can help to appropriately direct resources for pregnant patients and reduce the burden COVID-19 has placed on the healthcare system

Learn More – Primary Sources:

Initial clinical characteristics of gravid SARS-CoV-2 positive patients and the risk of progression to severe COVID-19 disease

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Related ObG Topics:

Can High Dose Nitric Oxide Improve Respiratory Function in Pregnant Women with Severe COVID-19?
Pregnant Women with COVID-19 and ICU Admissions
The UKOSS COVID-19 Pregnancy Registry: Update on 427 Patients Admitted to Hospital

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