Research Obstetrics| Volume 211, ISSUE 1, P39.e1-39.e8, July 2014

The Sepsis in Obstetrics Score: a model to identify risk of morbidity from sepsis in pregnancy

Published:March 11, 2014DOI:


      We sought to design an emergency department sepsis scoring system to identify risk of intensive care unit (ICU) admission in pregnant and postpartum women.

      Study Design

      The Sepsis in Obstetrics Score (S.O.S.) was created by modifying validated scoring systems in accordance with recognized physiologic changes of pregnancy. The S.O.S. was applied to a retrospective cohort of pregnant and postpartum patients from February 2009 through May 2011 with clinical suspicion of sepsis. The primary outcome was ICU admission. Secondary outcomes were telemetry unit admission, length of stay, positive blood cultures, positive influenza swabs, perinatal outcome, and maternal mortality. Receiver operating characteristic curves were constructed to estimate the optimal score for identification of risk of ICU admission.


      In all, 850 eligible women were included. There were 9 ICU (1.1%) and 32 telemetry (3.8%) admissions, and no maternal deaths. The S.O.S. had an area under the curve of 0.97 for ICU admission. An S.O.S. ≥6 (maximum score 28) had an area under the curve of 0.92 with sensitivity of 88.9%, specificity of 95.2%, positive predictive value of 16.7%, and negative predictive value of 99.9% for ICU admission, with an adjusted odds ratio of 109 (95% confidence interval, 18–661). An S.O.S. ≥6 was independently associated with increased ICU or telemetry unit admissions, positive blood cultures, and fetal tachycardia.


      A sepsis scoring system designed specifically for an obstetric population appears to reliably identify patients at high risk for admission to the ICU. Prospective validation is warranted.

      Key words

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      1. World Health Organization, UNICEF, UNFPA and The World Bank. Trends in maternal mortality: 1990 to 2010. Geneva, Switzerland: WHO Press, World Health Organization; 2012.

        • Chang J.
        • Elam-Evans L.D.
        • Berg C.J.
        • et al.
        Pregnancy-related mortality surveillance–United States, 1991-1999.
        MMWR Surveill Summ. 2003; 52: 1-8
        • Pollock W.
        • Rose L.
        • Dennis C.-L.
        Pregnant and postpartum admissions to the intensive care unit: a systematic review.
        Intensive Care Med. 2010; 36: 1465-1474
        • Bauer M.E.
        • Bateman B.T.
        • Bauer S.T.
        • Shanks A.M.
        • Mhyre J.M.
        Maternal sepsis mortality and morbidity during hospitalization for delivery: temporal trends and independent associations for severe sepsis.
        Anesth Analg. 2013; 117: 944-950
        • Dellinger R.P.
        • Levy M.M.
        • Rhodes A.
        • et al.
        Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock, 2012.
        Crit Care Med. 2013; 41: 580-637
        • Afessa B.
        • Green B.
        • Delke I.
        • Koch K.
        Systemic inflammatory response syndrome, organ failure, and outcome in critically ill obstetric patients treated in an ICU.
        Chest. 2001; 120: 1271-1277
        • Hazelgrove J.F.
        • Price C.
        • Pappachan V.J.
        • Smith G.B.
        Multicenter study of obstetric admissions to 14 intensive care units in southern England.
        Crit Care Med. 2001; 29: 770-775
        • Lapinsky S.E.
        • Hallett D.
        • Collop N.
        • et al.
        Evaluation of standard and modified severity of illness scores in the obstetric patient.
        J Crit Care. 2011; 26: 535.e1-535.e7
        • Lappen J.R.
        • Keene M.
        • Lore M.
        • Grobman W.A.
        • Gossett D.R.
        Existing models fail to predict sepsis in an obstetric population with intrauterine infection.
        Am J Obstet Gynecol. 2010; 203: 573.e1-573.e5
        • Stevens T.A.
        • Carroll M.A.
        • Promecene P.A.
        • Seibel M.
        • Monga M.
        Utility of acute physiology, age, and chronic health evaluation (APACHE III) score in maternal admissions to the intensive care unit.
        Am J Obstet Gynecol. 2006; 194: e13-e15
        • Vasquez D.N.
        • Estenssoro E.
        • Canales H.S.
        • et al.
        Clinical characteristics and outcomes of obstetric patients requiring ICU admission.
        Chest. 2007; 131: 718-724
        • Gabbe S.G.
        • Niebyl J.R.
        • Galan H
        • et al.
        Obstetrics: normal and problem pregnancies. 6th ed. Elsevier/Saunders, Philadelphia2012
        • Guinn D.A.
        • Abel D.E.
        • Tomlinson M.W.
        Early goal directed therapy for sepsis during pregnancy.
        Obstet Gynecol Clin North Am. 2007; 34 (xi): 459-479
        • Abbassi-Ghanavati M.
        • Greer L.G.
        • Cunningham F.G.
        Pregnancy and laboratory studies: a reference table for clinicians.
        Obstet Gynecol. 2009; 114: 1326-1331
        • Olsson T.
        • Terent A.
        • Lind L.
        Rapid Emergency Medicine score: a new prognostic tool for in-hospital mortality in nonsurgical emergency department patients.
        J Intern Med. 2004; 255: 579-587
        • Knaus W.A.
        • Draper E.A.
        • Wagner D.P.
        • Zimmerman J.E.
        APACHE II: a severity of disease classification system.
        Crit Care Med. 1985; 13: 818-829
        • Ghanem-Zoubi N.O.
        • Vardi M.
        • Laor A.
        • Weber G.
        • Bitterman H.
        Assessment of disease-severity scoring systems for patients with sepsis in general internal medicine departments.
        Crit Care. 2011; 15: R95
        • Kennedy M.
        • Joyce N.
        • Howell M.D.
        • Lawrence Mottley J.
        • Shapiro N.I.
        Identifying infected emergency department patients admitted to the hospital ward at risk of clinical deterioration and intensive care unit transfer.
        Acad Emerg Med. 2010; 17: 1080-1085
        • Subbe C.P.
        • Kruger M.
        • Rutherford P.
        • Gemmel L.
        Validation of a modified Early Warning Score in medical admissions.
        QJM. 2001; 94: 521-526
        • Sharma M.
        • Szpunar S.
        • Khatib R.
        Validating severity of illness scoring systems in the prediction of outcomes in Staphylococcus aureus bacteremia.
        Am J Med Sci. 2013; 346: 87-91
        • Paruk F.
        Infection in obstetric critical care.
        Best Pract Res Clin Obstet Gynaecol. 2008; 22: 865-883