Implementation of a maternal early warning system during early postpartum. A prospective observational study

Abstract

Objective To evaluate the implementation of a maternal early warning system (MEWS) for monitoring patients during the first two hours after delivery in a tertiary level hospital. Methods Implementation of the criteria between 15 March and 15 September 2018 was evaluated in 1166 patients. The parameters collected were systolic and diastolic blood pressure, heart rate, oxygen saturation, urine output, uterine involution, and bleeding. Out-of-range values of any of these parameters triggered a warning, and an obstetrician was called to examine the patient. The obstetrician then decided whether to call the anesthesiologist. We carried out a sensitivity-specificity study of triggers and a multivariate analysis of the factors involved in developing potentially fatal disorders (PFD), reintervention, critical care admission, and stay. Results The MEWS was triggered in 75 patients (6.43%). Leading trigger was altered systolic blood pressure in 32 patients (42.7%), and 11 patients had a PFD. Twenty-eight triggers were false-negatives. Sensitivity and specificity of the system was 0.28 (0.15, 0.45) and 0.94 (0.93, 0.96), respectively. The multivariate analysis showed a correlation between trigger activation and PFD. Conclusion Our MEWS presented low sensitivity and high specificity, with a significant number of false-negatives.

Influence of a Training Module on the Knowledge of Midwives Concerning Postpartum Warning Signs at the Primary Health Care Level in Osun State, Nigeria

“…However, early warning signs were seldom recognised. [1,2] Midwives play a critical role in advocating for the overall health of both mother and child during this period. [3] One of their essential responsibilities is knowing about the warning signs that could indicate complications.…”

The Importance of the Novel Postpartum Uterine Ultrasonographic Scale in Numerical Assessments of Uterine Involution Regarding Perinatal Maternal and Fetal Outcomes

“…The Committee on Practice Bulletins-Obstetrics [9] encourages obstetric care providers to play key roles in implementing standardized bundles of care (policies, guidelines, and algorithms) for the management of postpartum hemorrhage. Ibanez [10] evaluated the implementation of a maternal early warning system for monitoring patients during the first two hours after delivery; the parameters collected included uterine involution and bleeding, and demonstrated low sensitivity, high specificity, with a significant number of false negatives. Thus, more research was required.…”