A Prediction Score for Maternal Mortality in Senegal and Mali

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OBJECTIVE:To develop and validate a maternal mortality score to identify patients at risk of in-hospital death in developing countries.METHODS:We performed a prospective observational study in 46 referral hospitals in Senegal and Mali, starting October 1, 2007. Derivation of a maternal mortality score was performed, using generalized estimating equation, on patients included during the first 6 months of the study (301 deaths out of 43,624 deliveries) and validated on patients included during the next 6 months (345 deaths out of 46,328 deliveries).RESULTS:Nine criteria were independently associated with maternal death: severe anemia in pregnancy, malaria diagnosed during pregnancy, parity greater than 4, fewer than three antenatal visits, referral from another health facility, antepartum or postpartum hemorrhage, preeclampsia or eclampsia, uterine rupture, and genital infection or sepsis. The maternal mortality score, ranging from 0 to 100, occupies an area under the receiver operating characteristics curve of 0.89 (95% confidence interval [CI] 0.87–0.91). The low-risk group for maternal mortality, based on a score less than 10, has a negative predictive value of 99.9% (95% CI 99.8–99.9) and a negative likelihood ratio of 0.18, ruling out maternal mortality with a probability of 0.13% (95% CI 0.09–0.17). Sensitivity of the score to identify patients at risk of in-hospital death was 85.0% (95% CI 80.5–88.8). Validation of the score yielded a sensitivity of 87.8% (95% CI 83.9–91.1), a negative predictive value of 99.9% (95% CI 99.8–99.9), and a probability of maternal death of 0.12% (95% CI 0.08–0.17) in the low-risk group.CONCLUSION:The maternal mortality score could help health care professionals to identify patients at risk of maternal mortality who need careful management.LEVEL OF EVIDENCE:III

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