Maternal and perinatal outcomes of obstetric acute respiratory distress syndrome defined by the new global framework.

OBJECTIVE

This study evaluates predictors of maternal mortality in obstetric acute respiratory distress syndrome (ARDS) defined as per the new global ARDS framework definition.

METHODS

We retrospectively reviewed electronic medical records of obstetric patients (≥28 weeks' gestation to 6 weeks postpartum) between 2016 and 2021 fulfilling the new global ARDS criteria and classified them into Berlin and non-Berlin ARDS groups. Maternal mortality was analyzed using logistic regression and survival analysis.

RESULTS

Among 132 obstetric patients meeting the new global ARDS framework criteria, 102 fulfilled the Berlin ARDS definition. Overall maternal mortality was 49.2%, with 63 of 65 deaths occurring in the Berlin ARDS subgroup. On unadjusted logistic regression, severe ARDS, blood lactate >2 mmol/L, Berlin ARDS, and organ dysfunction were strongly associated with mortality. After adjustment, severe ARDS (adjusted odds ratio [aOR] 10.60, 95% confidence interval [CI] 1.93-88.69) and blood lactate >2 mmol/L (aOR 4.50, 95% CI 1.21-18.81) remained independently associated with death. In adjusted Cox models, Berlin ARDS (adjusted hazard ratio [aHR] 5.55, 95% CI 1.64-18.70), blood lactate >2 mmol/L, severe disease, undelivered status (aHR 7.73, 95% CI 3.00-19.92), and vasopressor use (aHR 2.17, 95% CI 1.15-4.10) were independent predictors of maternal mortality.

CONCLUSION

Severe ARDS, hyperlactatemia, Berlin ARDS classification, undelivered status, and vasopressor use independently predicted maternal mortality in obstetric ARDS defined by the new global ARDS framework.