Sepsis in Obstetrics Score Predicts Maternal Adverse Outcomes

The Sepsis in Obstetrics Score (SOS) was designed to identify pregnant and postpartum patients at risk for morbidity due to infection during emergency visits. SOS is cited by both SMFM and ACOG sepsis and critical care guidelines. As such, we sought to determine if SOS was predictive of maternal adverse outcomes in our obstetric population. A retrospective cohort study was conducted of pregnant and postpartum patients with infection at a single tertiary center from 10/1/15-8/31/20. SOS score was calculated with use of admission vital signs and laboratory values. Those with a score ³ 6 were considered to have a positive screen. Patients were categorized as those with or without maternal adverse outcomes (MAO). MAO is comprised of ³ 1 of the criteria as defined in Table 1. Continuous data was analyzed with Wilcoxon Rank-Sum Test. Categorical variables were analyzed using Fisher’s Exact Test. Sensitivity and specificity, positive and negative predictive values, and likelihood ratios were calculated with 95% confidence intervals for detection of MAO by positive SOS screen. 205 patients met inclusion criteria. 43.9% had MAO. 7.3% of all patients had a positive SOS screen. 13.3% of those with MAO had a positive SOS score (Table 1). Of those with a positive SOS screen, 66.7% required maternal intensive care unit admission. SOS scores ranged from 6 to 13 and 6 to 8 for those with and without MAO, respectively. The sensitivity and specificity of SOS for MAO was 13.3% (7.4-22.5) and 97.4% (92.0-99.3), respectively. The positive and negative predictive values of SOS for MAO was 80.0% (51.4-94.7) and 58.9% (51.6-65.9), respectively. The positive and negative likelihood ratios of SOS for MAO was 5.1 (1.5-17.6) and 0.9 (0.8-1.0), respectively. While a positive SOS screen only identified 13% of women with MAO, those with a positive screen were 5 times as likely to have MAO as those without. Pregnant women with a positive SOS screen should be monitored cautiously, but those without a positive screen remain at risk for MAO.