Early detection of severe maternal morbidity: A retrospective assessment of the role of an Early Warning Score System

Austin, Diana; Sadler, Lynn; McLintock, Claire; McArthur, Colin; Masson, Vicki; Farquhar, Cindy; Rhodes, S.

doi:10.1111/ajo.12160

Cited by 24 publications

(18 citation statements)

References 8 publications

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“…This is similar to other studies confirming that clinical education needs to focus on clinician factors in diagnosis and treatment of the leading causes of SMM. [27][28][29] A SMM preventability review can therefore be used to inform interventions to improve maternity care through clinician education, audit and feedback and/or system changes. After a review of maternal deaths in Illinois, an obstetric hemorrhage preparedness training for all maternity providers was mandated and has shown a significant reduction in hemorrhage-related deaths as a result of reduction in provider preventability factors and an increase in institution emergency preparedness.…”

Section: Discussionmentioning

confidence: 99%

Preventability review of severe maternal morbidity

Lawton

MacDonald

Stanley

et al. 2019

Acta Obstet Gynecol Scand

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Introduction:Severe maternal morbidity (SMM) is rising globally. Assessing SMM is an important quality measure. This study aimed to examine SMM in a national cohort in New Zealand. Material and methods:This is a national retrospective review of pregnant or postpartum women admitted to an Intensive Care Unit or High Dependency Unit during pregnancy or recent postpartum. Outcomes were rates of SMM and assessment of potential preventability. Preventability was defined as any action on the part of the provider, system or patient that may have contributed to progression to more severe morbidity, and was assessed by a multidisciplinary review team.Results: Severe maternal morbidity was 6.2 per 1000 deliveries (95% confidence interval 5.7-6.8) with higher rates for Pacific, Indian and other Asian racial groups.Major blood loss (39.4%), preeclampsia-associated conditions (23.3%) and severe sepsis (14.1%) were the most common causes of SMM. Potential preventability was highest with sepsis cases (56%) followed by preeclampsia and major blood loss (34.3% and 30.9%). Of these cases, only 36.4% were managed appropriately as determined by multidisciplinary review. Provider factors such as inappropriate diagnosis, delay or failure to recognize high risk were the most common factors associated with potential preventability of SMM. Pacific Island women had over twice the rate of preventable morbidity (relative risk 2.48, 95% confidence interval 1.28-4.79). Conclusions:Multidisciplinary external anonymized review of SMM showed that over a third of cases were potentially preventable, being due to substandard provider care with increased preventability rates for racial/ethnic minority women. Monitoring country rates of SMM and implementing case reviews to assess potential preventability are appropriate quality improvement measures and external review of anonymized cases may reduce racial profiling to inform unbiased appropriate interventions and resource allocation to help prevent these severe events. K E Y W O R D Spreventability, quality audit, severe maternal morbidity

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Section: Discussionmentioning

confidence: 99%

Preventability review of severe maternal morbidity

Lawton

MacDonald

Stanley

et al. 2019

Acta Obstet Gynecol Scand

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“…In New Zealand, an obstetric EWS was retrospectively applied to a random sample of cases of severe maternal morbidity from January 2010 to December 2011 [17]. Notably, seven different observation charts were used in the maternity unit at Auckland City Hospital.…”

Section: Discussionmentioning

confidence: 99%

Maternal bacteremia and the Irish maternity early warning system

Maguire

O’Higgins

Power

et al. 2015

International Journal of Gynecology & Obstetrics

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“…[8][9][10][11] Therefore, the use of early warning systems (EWS) have been proposed as a potential tool to reduce maternal morbidity and mortality, based on identification of predetermined abnormal values (warning signs) to generate a rapid and effective medical response. [12][13][14][15] Several EWS have been developed for obstetrical patients, but the majority are the result of a clinical consensus rather than statistical analyses of clinical outcome measures (ie, maternal deaths). [14][15][16][17][18] In 2013, Carle et al, 19 with the Intensive Care National Audit and Research Center (ICNARC) Case Mix Program in the United Kingdom, designed and internally validated a statistically derived, clinically modified, Obstetric Early Warning Score (OEWS) using 4440 obstetric admission to the intensive care unit (ICU) that showed a good predictive ability to discriminate survivors from nonsurvivors.…”

Section: Introductionmentioning

confidence: 99%