Implementation of the Maternal Early Warning Criteria during early postpartum. A prospective observational study

Abstract

Objective: To evaluate the implementation of an early warning system in obstetric patients (MEWC) during the first two hours after delivery in a tertiary-care hospital. Method: The MEWC system implementation was carried out from 15th March to 15th September 2018, over 1166 patients. The parameters collected were systolic and diastolic blood pressure, heart rate, oxygen saturation, diuresis, uterine involution, and bleeding. A trigger was defined as any abnormal parameter that prompted the need for bedside examination by an obstetrician and an anesthesiologist. We carried out a sensitivity-specificity study of the trigger and multivariate analysis of the factors involved in developing potentially fatal disorders (PFD), reintervention, critical care admission and stay. Results: The protocol was triggered in 75 patients (6.43%). The leading cause of alarm activation was altered systolic blood pressure (32 [42.7%] patients), followed by obstetric causes (24 [32%] patients). Of these patients, eleven developed PFD. Twenty-eight patients were false-negatives. Sensitivity and specificity of MEWC protocol were 0.28 (0.15, 0.45) and 0.94 (0.93, 0.96), respectively. Multivariate analysis showed a relationship between alarm activation and PFD. Conclusions: Our MEWC protocol presented low sensitivity and high specificity, having a significant number of false-negative patients.