Factors Associated With Elevated Sepsis in Obstetrics Scores Among Antenatal Women: An Analytical Study

Background Maternal sepsis remains a major cause of maternal morbidity and mortality, particularly in resource-limited settings where early recognition is often delayed. However, conventional sepsis scoring systems have limited applicability in pregnancy because physiological adaptations of gestation can mimic features of sepsis and affect score performance, highlighting the potential role of pregnancy-specific tools, such as the Sepsis in Obstetrics Score (SOS), for risk stratification. Materials and methods This analytical cross-sectional study was conducted at a tertiary care center in Bhopal, India, from January 2022 to January 2023. A total of 450 antenatal women with suspected infection were included. The SOS was calculated at admission using pregnancy-adjusted physiological and laboratory parameters and categorized as low risk (SOS <6) or high risk (SOS ≥6), indicating increased risk of severe sepsis-related adverse outcomes. Associations between clinical variables and elevated SOS were assessed using the chi-square test with odds ratios (OR). Continuous variables were compared using the independent samples t-test. Multivariable logistic regression analysis identified independent predictors of elevated SOS. Results Among the 450 participants, 50 (11.1%) were categorized as high risk (SOS ≥6). Significant predictors of elevated SOS included ≥4 vaginal examinations, premature rupture of membranes (PROM), PROM lasting >24 hours, and abnormal vaginal discharge. Multivariable analysis identified PROM >24 hours (adjusted OR (aOR) 3.48), ≥4 vaginal examinations (aOR 3.05), and abnormal vaginal discharge (aOR 2.21) as independent predictors. Women with elevated SOS scores demonstrated significant physiological derangements. Conclusions The SOS may be useful as a bedside risk-stratification tool among antenatal women with suspected infection. Elevated SOS was primarily associated with modifiable intrapartum and infection-related factors, highlighting potential opportunities for preventive obstetric interventions.