(778) OB Patients Admitted to Maternity Wards Compared to the ICU: A Systematic Review and Meta-Analysis

Sunday, February 23, 2025

12:15pm – 1:15pm Eastern Time

Location: Connections Central - RST 02

First Author(s)

Jennifer A. Walker, MD (she/her/hers)

Baylor Scott & White All Saints Medical Center
Fort Worth, Texas, USA

Co-Author(s)

Quincy K. Tran, MD, PhD, FACEP

University of Maryland Medical Center, R. Adams Cowley Shock Trauma Center
Baltimore, Maryland, USA
NJ

Natalie Jackson, MD

Resident Physician
Baylor Scott and White All Saints Medical Center Fort Worth, United States
SR

Sudha Ramakrishnan, n/a

Associate Librarian
Baylor Scott & White Research Institute, United States
AG

Anandita Gaur, n/a

Undergraduate Student
Research Associate Program in Emergency Medicine and Critical Care, United States
SP

Saad Pirzada, BS

Medical Student
University of Maryland Medical Center, United States
AS

Anna Shaw, N/A

Undergraduate Student
Research Associate Program in Emergency Medicine and Critical Care, United States
CP

Claire Perry, N/A

Undergraduate Student
Research Associate Program in Emergency Medicine and Critical Care, United States

Introduction: Patients admitted to wards who decompensate and upgrade to ICU have worse outcomes. This holds true for peripartum patients; yet little literature exists regarding the utility of clinical scores in peripartum patients used to identify patients at admission who may decompensate. Also, scores may differ in peripartum patients due to physiologic changes of pregnancy. The goal of this systematic review and meta-analysis is to determine which clinical score may identify patients who can safely be admitted to a maternity ward vs. those who may benefit from ICU admission.

Methods: We searched Ovid MEDLINE, PubMed, Embase, Web of Science and Google Scholar through November 2023. Observational or randomized control studies comparing clinical scores of adult peripartum patients admitted to the wards to those who required ICU were included. Only full text articles were included. We excluded reviews, case reports, abstracts and pregnancies with known complications.

The primary outcome was SOFA score. Secondary outcomes were Sepsis in Obstetrics Score (SOS), hospital length of stay (HLOS) and mortality. We used random-effects meta-analysis to compare outcomes. Heterogeneity between studies was assessed with the I2 value.

Results: We screened 3938 titles and 41 full text articles with 9 articles meeting inclusion criteria. All studies were observational and included 21637 patients. 434 patients were ICU-level patients and 21203 were control group. ICU-level patients were associated with higher SOFA score (difference of mean 3.55, p=0.038). SOS score was statistically higher in ICU patients (difference of mean 1.19, p=0.042). ICU patients had higher mortality (490x odds) and HLOS (mean difference 2 days, p=0.004).

Conclusions: Differentiating peripartum patients safe for admit to the floor versus those at risk for decompensation who may benefit from ICU admit is a feasible way to prevent morbidity. This study demonstrates that some physiologic scores appear to differentiate these patients; however, heterogeneity was high due to observational nature of all studies. There were also differing definitions of ICU upgrade. Further research should specifically evaluate clinical scores at ward admission vs. patients who later upgrade to the ICU.