Use of Maternal Early Warning Trigger Tool Reduces Maternal Morbidity

Shields, Laurence E.; Wiesner, Suzanne; Klein, Catherine; Pelletreau, Barbara; Hedriana, Herman L.

doi:10.1097/01.ogx.0000490084.45867.98

Cited by 33 publications

(82 citation statements)

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“…More than a third of women were started on (additional) antihypertensive medication only after a second reading of severe hypertension, whereas almost half of women developed eclampsia after the first measurement of severe hypertension, before blood pressure was normalized. In these women there was considerable delay in reducing blood pressure, illustrating the need for specific algorithms and goal‐directed therapy, for instance by using Preeclampsia Toolkits . Dutch national guidelines still include repeated measurements following a first measurement of severe hypertension, and include no target blood pressure levels or time intervals.…”

Section: Discussionmentioning

confidence: 99%

A national surveillance approach to monitor incidence of eclampsia: The Netherlands Obstetric Surveillance System

Schaap

Akker

Zwart

et al. 2018

Acta Obstet Gynecol Scand

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Introduction:There have been many efforts in the last decade to decrease the incidence of eclampsia and its related complications in the Netherlands, such as lowering thresholds for treatment of hypertension and mandatory professional training. To determine the impact of these policy changes on incidence and outcomes, we performed a nationwide registration of eclampsia, 10 years after the previous registration. Material and methods:Cases of eclampsia were prospectively collected using the Netherlands Obstetric Surveillance System (NethOSS;-2016 in all hospitals with a maternity unit in the Netherlands. Complete case file copies were obtained for comparative analysis of individual level data with the previous cohort (2004)(2005)(2006). Primary outcome measure was incidence of eclampsia; main secondary outcomes were antihypertensive and magnesium sulfate use, and maternal and perinatal mortality. Results: NethOSS identified 88 women with eclampsia. The incidence decreased from 6.2/10 000 in 2004-2006 to 1.8/10 000 births (relative risk [RR] 0.28, 95% confidence interval [CI] 0.22-0.36). Increases in the use of antihypertensive medication (61/82 vs 35/216; RR 18.4, 95% CI 9.74-34.70) and magnesium sulfate treatment (82/82 vs 201/216; RR 1.08, 95% CI 1.04-1.12) were observed. There was one intrauterine death following termination of pregnancy. No cases of neonatal mortality were reported in NethOSS compared with 11 in the LEMMoN. Maternal death occurred in one woman compared vs three in the previous registration. Conclusions: There has been a strong reduction of eclampsia and associated perinatal mortality in the Netherlands over the last decade. Management changes and increased awareness may have contributed to this reduction. K E Y W O R D S eclampsia, INOSS, maternal morbidity, NethOSS, obstetric surveillance system 1 | INTRODUC TI ON Hypertensive disorders of pregnancy (HDP) have multiple clinical expressions and complicate approximately 10% of all pregnancies. 1 A decade ago, both the UK and the Netherlands performed nationwide prospective registrations of eclampsia, a state of convulsions in women with HDP. 2,3 Comparative analysis showed that the incidence of eclampsia in the Netherlands was twice as high as in the UK. 4 Individual case-by-case analysis indicated that women with HDP and (pre)eclampsia in the Netherlands were managed less

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Section: Discussionmentioning

confidence: 99%

A national surveillance approach to monitor incidence of eclampsia: The Netherlands Obstetric Surveillance System

Schaap

Akker

Zwart

et al. 2018

Acta Obstet Gynecol Scand

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“…11 Subsequently, the same authors prospectively implemented the use of the MEWT in six hospitals, which provided maternity care as a part of patient safety program for obstetric care. 10 The authors found that implementation of the MEWT resulted in significant reductions in patient morbidity and mortality, although there was no difference in frequency of ICU admission. 10…”

Section: Maternal Early Warning Triggermentioning

confidence: 96%

“…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%

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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“…Despite some indications that early warning systems can contribute to earlier identification of deterioration (Carle, Alexander, Columb, & Johal, 2013;Shields, Wiesner, Klein, Pelletreau, & Hedriana, 2016), the majority of available studies have attempted to validate the use of maternity early warning tools, scores and triggers only in specific populations of women (Edwards et al, 2015; Maguire et al, 2016). This limits our understanding of how effective such tools are in a general population of hospitalised women in the maternity context.…”

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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Use of Maternal Early Warning Trigger Tool Reduces Maternal Morbidity

Cited by 33 publications

References 0 publications

A national surveillance approach to monitor incidence of eclampsia: The Netherlands Obstetric Surveillance System

A national surveillance approach to monitor incidence of eclampsia: The Netherlands Obstetric Surveillance System

Predictors of Maternal Mortality and Prognostic Models in Obstetric Patients

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

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