Bateman et al developed a comorbidity index for pregnant women. This can help to identify a woman who may benefit from more aggressive management. The authors are from Brigham and Women's Hospital, Massachusetts General Hospital, Harvard University, University of Michigan and the Centers for Disease Control and Prevention.
Patient selection: pregnant woman
Outcome: end-organ damage or death
Parameters:
(1) age in years
(2) chronic congestive heart failure
(3) congenital heart disease
(4) pulmonary hypertension
(5) chronic ischemic heart disease
(6) sickle cell disease
(7) multiple gestation
(8) cardiac valvular disease
(9) systemic lupus erythematosus (SLE)
(10) HIV
(11) drug abuse
(12) placenta previa
(13) chronic renal disease
(14) pre-existing hypertension
(15) previous cesarean delivery
(16) alcohol abuse
(17) asthma
(18) pre-existing diabetes mellitus
(19) pregnancy-related hypertensive disorder
|
Parameter |
Finding |
Points |
|
age in years |
< 35 years |
0 |
|
|
35 to 39 years |
1 |
|
|
40 to 44 years |
2 |
|
|
> 44 years |
3 |
|
chronic CHF |
absent |
0 |
|
|
present |
5 |
|
congenital heart disease |
absent |
0 |
|
|
present |
4 |
|
pulmonary hypertension |
absent |
0 |
|
|
present |
4 |
|
chronic ischemic heart disease |
absent |
0 |
|
|
present |
3 |
|
sickle cell disease |
absent |
0 |
|
|
present |
3 |
|
multiple gestation |
no |
0 |
|
|
yes |
2 |
|
cardiac valvular disease |
absent |
0 |
|
|
present |
2 |
|
SLE |
absent |
0 |
|
|
present |
2 |
|
HIV |
absent |
0 |
|
|
present |
2 |
|
drug abuse |
no |
0 |
|
|
yes |
2 |
|
placenta previa |
absent |
0 |
|
|
present |
2 |
|
chronic renal disease |
absent |
0 |
|
|
present |
1 |
|
pre-existing hypertension |
absent |
0 |
|
|
present |
1 |
|
previous cesarean delivery |
absent |
0 |
|
|
present |
1 |
|
alcohol abuse |
no |
0 |
|
|
yes |
1 |
|
asthma |
absent |
0 |
|
|
present |
1 |
|
pre-existing diabetes |
absent |
0 |
|
|
presnet |
1 |
|
hypertensive disorder |
absent |
0 |
|
|
severe preeclampsia or eclampsia |
5 |
|
|
mild or unspecified eclampsia |
2 |
|
|
gestational hypertension without pre-existing hypertension |
1 |
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 45
• The higher the score the greater the maternal morbidity and mortality.
Performance:
• The area under the ROC curve was 0.66.
