Know These Signs: Maternal Early Warning Criteria Proposed

Troy Brown, RN

September 10, 2014

Almost half of maternal deaths in the United States, France, and United Kingdom are preventable and result from delays in recognition, diagnosis, and treatment of hemorrhage, hypertension, infection, and venous thrombosis. Now, the National Partnership for Maternal Safety has proposed criteria for an early warning system.

The partnership presents the new Maternal Early Warning Criteria in a commentary published online September 5 in Obstetrics & Gynecology.

Jill M. Mhyre, MD, from the Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, and colleagues developed the guidelines on behalf of the National Partnership for Maternal Safety. Using a consensus-based approach, they identified a list of abnormal parameters that require urgent evaluation and escalation of care if needed.

"In obstetric patients, the early signs of life-threatening illness can be difficult to recognize because critical illness is relatively rare, normal pregnancy and childbirth can generate significant changes in maternal vital signs, and healthy women have substantial physiologic reserve to compensate for pathologic derangements," they explain.

The system is a single-parameter scoring system that includes assessment of heart rate (<50 or >120 beats per minute), systolic blood pressure (<90 or >160 mm Hg), diastolic blood pressure (>100 mm Hg), respiratory rate (<10 or >30 breaths per minute), oxygen saturation on room air at sea level (<95%), the presence of oliguria (<35 mL/hour for ≥2 hrs), or maternal agitation, confusion, or unresponsiveness.

In addition, patients with preeclampsia who report a nonremitting headache or shortness of breath also require immediate clinical evaluation.

"All women who meet any of The Maternal Early Warning Criteria should receive prompt bedside evaluation by a physician or other clinician with the ability to activate resources in order to initiate emergency diagnostic and therapeutic interventions as needed," the authors write.

Early warning systems for other patient populations are typically multiparameter aggregate-weighted systems that assign a score according to the degree of abnormality for each measured parameter and that use the total of those scores to determine the need for medical evaluation.

However, aggregate-weighted tools may not be most appropriate for obstetric patients, the authors note. Of the maternal deaths that were studied, a disproportionate number of women had "frankly abnormal vital signs" that would have been picked up by the single-parameter system. In addition, aggregate-weighted score tools are more time consuming, which may reduce the level of compliance with their use.

The committee also developed a series of differential diagnoses for each of the parameters measured in the Maternal Early Warning Criteria. The lists include common conditions as well as those that are rare but serious.

The authors have disclosed no relevant financial relationships.

Obstet Gynecol. Published online September 5, 2014. Abstract

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