Prediction of Adverse Maternal Outcome In Women With Preeclampsia By Full PIERS Model.

Abstract

Preeclampsia is a pregnancy-specific disorder and one of the leading causes of maternal and perinatal morbidity and mortality in Bangladesh. Identification of women at increased risk of developing severe complications from preeclampsia is important to manage timely in appropriate settings. A fullPIERS model is a new tool that could allow real-time maternal risk stratification in preeclampsia to aid caregivers and also guide decisions around triage, transport and treatment. This prospective cohort study was conducted in the Department of Fetomaternal Medicine, Bangladesh Medical University (BMU), Dhaka, Bangladesh to estimate the predictive value of fullPIERS model for adverse maternal outcomes in preeclampsia. A total of 103 admitted women with preeclampsia between 20-40 weeks of gestation were enrolled fulfilling the selection criteria. Immediately after admission fullPIERS scoring was done and adverse maternal outcome observed within 48 hours and 7 days of admission was documented. The fullPIERS score ≥30.0% (according to the NICE guideline) was considered the baseline cut-off score. Among all respondents, 11 patients were observed with high score (≥30.0%) group six developed adverse outcomes and rest of 92 low score (<30.0%) group three developed adverse maternal outcome within 7 days. Patients with a high score had 16.727 times more chance to develop adverse maternal outcomes compared to those with the score <30% (p= <0.001; RR=16.727; 95% CI=4.856 to 57.621). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy rate at fullPIERS score ≥30.0% was found 66.67%, 93.62%, 50.01%, 96.70% and 91.26%, respectively. In this study the cut-off value of risk score 12.0% in fullPIERS model was determined through ROC curve for the studied population. Among the respondents who had fullPIERS score ≥12.0% had 19.03 times more risk to develop adverse maternal outcomes within 7 days (p=0.001; RR=19.031; 95% CI=4.339-83.460). Hence, reduced cut-off value of fullPIERS score to 12.0% strengthens the predictive values of the model for detection of adverse maternal outcomes with reported the sensitivity, specificity, positive predictive value, negative predictive value and accuracy rate of 77.78%, 90.43%, 43.63%, 97.71% and 89.33%, respectively. The fullPIERS model is a useful tool to identifying patients who are at risk of greater complications and need for specialized care, thus can reduce maternal morbidity and mortality relating to preeclampsia.