Baseline assessment of a hospital-specific early warning trigger system for reducing maternal morbidity

Hedriana, Herman L.; Wiesner, Suzanne; Downs, Brenda; Pelletreau, Barbara; Shields, Laurence E.

doi:10.1016/j.ijgo.2015.07.036

Cited by 32 publications

(36 citation statements)

References 16 publications

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“…This limits our understanding of how effective such tools are in a general population of hospitalised women in the maternity context. However, there are indications that implementing a maternity early warning system can costeffectively reduce harm from maternal morbidity in hospitalised women (Hedriana, Wiesner, Downs, Pelletreau, & Shields, 2016;Hess, Hoffmann, Shields, & Caughey, 2017). It is clear that there is wide variation in the parameters used as part of an early warning tool (for example, respiratory rate, heart rate, proteinuria or lochia), and in the specific trigger thresholds within each parameter; for example, a respiratory rate of 25 may indicate abnormality in one tool but be considered normal in another (Bick et al, 2014;Smith et al, 2017).…”

Section: Literature Scanmentioning

confidence: 99%

Recognising and responding to acutely deteriorating women in New Zealand maternity wards: A literature and environmental scan

Dann¹,

Hill²

2018

nzcomjnl

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Most women are healthy throughout their pregnancies but, for a small number, pregnancy will be complicated by a significant morbidity experience. It is estimated that approximately 1% of all births in England are severely complicated (Waterstone, Bewley, & Wolfe, 2001), although that is thought likely to underestimate the current United Kingdom (UK) situation (Knight et al., 2016). Maternal morbidity review is a quality improvement initiative that

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Section: Literature Scanmentioning

confidence: 99%

Recognising and responding to acutely deteriorating women in New Zealand maternity wards: A literature and environmental scan

Dann¹,

Hill²

2018

nzcomjnl

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“…37,78 The aim of these scoring systems, specifically designed for groups of obstetric patients receiving non-ICU care, is to reduce maternal morbidity and mortality by early recognition of high-risk patients and the subsequent triggering of a rapid and effective medical response. 11,37 While some of these newly developed maternal warning systems are specific for particular maternal conditions (sepsis, eclampsia, venous thromboembolism), 37 others are more comprehensive. 78,79 Most of these maternal early warning scores have been developed retrospectively and have yet to be implemented prospectively.…”

Section: Obstetric Prediction Modelsmentioning

confidence: 99%

“…78,79 Most of these maternal early warning scores have been developed retrospectively and have yet to be implemented prospectively. 11,12 Modified Early Obstetric Warning System…”

Section: Obstetric Prediction Modelsmentioning

confidence: 99%

“…9 Therefore, the use of predictive models has been proposed as a potential tool to reduce maternal morbidity and mortality, by aiding in the timely identification of potential high-risk patients. [8][9][10][11][12][13][14] Pregnant or peripartum women with life-threating complications are treated in different levels of care, including delivery suites, high dependency units (step-down units), and intensive care units (ICUs) based on inclusion criteria and bed availability. 12,15,16 Women admitted to an ICU usually have a higher severity of illness than women treated outside an ICU.…”

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confidence: 99%

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Predictors of Maternal Mortality and Prognostic Models in Obstetric Patients

Levinson

Miranda

Rojas-Suarez

2017

Semin Respir Crit Care Med

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The use of predictive models has been proposed as a potential tool to reduce maternal morbidity and mortality, by aiding in the timely identification of potential high-risk patients. Prognostic models in critical care have been used to characterize the severity of illness of specific diseases. Physiological changes in pregnancy may result in general critical illness prediction models overestimating mortality in obstetric patients. Models that specifically reflect the unique characteristics of obstetric patients may have better prognostic value. Recently developed tools have focused on identifying at-risk patients before they require intensive care unit (ICU) admission to target early interventions and prevent acute clinical decompensation. The aim of the newest scoring systems, specifically designed for groups of obstetric patients receiving non-ICU care, is to reduce maternal morbidity and mortality by identifying early high-risk patients and initiating prompt effective medical responses.

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“…The SOS included temperature, systolic blood pressure, heart rate, respiratory rate, blood oxygen saturation, WBC, immature neutrophils, and lactic acid (Albright et al, 2015). In another study, a reduced number of ICU admissions resulted from the routine use of maternal early warning triggers (MEWTs) (Hedriana, Wiesner, Downs, Pelletreau, & Shields, 2016). Sepsis MEWTs included temperature plus another MEWT (respiratory rate, maternal heart rate, or respiratory rate), to initiate escalation for further assessment for sepsis .…”

Section: Routine Screening and Use Of A Sepsis Pathwaymentioning

confidence: 99%

Retrospective Analysis of Obstetric Sepsis Screening

Champagne

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RETROSPECTIVE ANALYSIS OF OBSTETRIC SEPSIS SCREENINGThis project was designed to evaluate outcomes following implementation of routine screening for sepsis in the obstetric population. A retrospective analysis of the electronic medical record of 204 women who met sepsis criteria using obstetric-adjusted systemic inflammatory response syndrome (SIRS) criteria and a source of infection was the method used. Outcomes were evaluated for neonates born to the women who developed sepsis during labor. The incidence of sepsis was 0.401 per1,000 and included those with antepartum, intrapartum, or postpartum admissions. The setting was a tertiary center with 5,075 deliveries over the study period. There were 92 (45.2%) who had sepsis, 87 (42.6%) who had severe sepsis, and 25 (12.3%) who met septic shock criteria. There were no deaths and two ICU admissions. Mean lactic acid level for women with sepsis (N=203) was 2.4 +-1.3 mmol/L. Fourteen combinations of positive SIRS criteria were present; no combination was uniquely associated with the severity of sepsis. An Apgar score of ≤ 6 at one-and five-minutes of age was more likely when the mother developed sepsis in labor, odds ratio 12.1 (95% confidence interval, 7.86, 18.61) for the one-minute Apgar, and 3.06 (95% confidence interval 1.40, 6.75)for the five-minute Apgar score. The use of a standardized process for screening for sepsis provided for early identification and timely treatment of obstetric women with sepsis. Neonates born to women who met sepsis criteria in labor were more likely to require resuscitation at the time of birth than those born to women without sepsis.

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Baseline assessment of a hospital-specific early warning trigger system for reducing maternal morbidity

Abstract: Persistent MEWTs were present in most obstetric ICU cases. Retrospectively, MEWTs in this cohort seemed to separate normal obstetric patients from those for whom ICU admission was indicated; their use might reduce maternal morbidity.

Cited by 32 publications

References 16 publications

Recognising and responding to acutely deteriorating women in New Zealand maternity wards: A literature and environmental scan

Recognising and responding to acutely deteriorating women in New Zealand maternity wards: A literature and environmental scan

Predictors of Maternal Mortality and Prognostic Models in Obstetric Patients

Retrospective Analysis of Obstetric Sepsis Screening

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