Baseline assessment of a hospital-specific early warning trigger system for reducing maternal morbidity

International Journal of Gynaecology and Obstetrics : the Official Organ of the International Federation of Gynaecology and Obstetrics
Herman L HedrianaLaurence E Shields

Abstract

To determine whether predefined maternal early warning triggers (MEWTs) can predict pregnancy morbidity. In a retrospective case-control study, obstetric patients admitted to the intensive care unit (ICU) between 2012 and 2013 at seven pilot US hospitals were compared with control patients who had a normal delivery outcome. Six MEWTs were assessed. The case and control groups each contained 50 patients. Hemorrhage (15/50, 30%), sepsis (12/50, 24%), cardiac dysfunction (8/50, 16%), and pre-eclampsia (6/50, 12%) were the most common reasons for ICU admission. Significant associations were recorded between ICU admission and tachycardia (OR 5.0, 95% CI 2.1-11.7), mean arterial pressure less than 65 mm Hg (OR 4.5, 95% CI 1.9-10.8), temperature of at least 38°C (OR 44.1, 95% CI 13.0-839.1), and altered mental state (OR 44.1, 95% CI 13.1-839.0). Two or more triggers were persistent for 30 minutes or more in 36 (72%) ICU patients versus 2 (4%) controls (OR 61.7, 95% CI 13.2-288.0). Earlier medical intervention might have led to a lesser degree of maternal morbidity for 31 (62%) ICU patients with at least one MEWT. Persistent MEWTs were present in most obstetric ICU cases. Retrospectively, MEWTs in this cohort seemed to separate normal ...Continue Reading

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Citations

Mar 1, 2016·American Journal of Obstetrics and Gynecology·Laurence E ShieldsHerman L Hedriana
Oct 25, 2016·American Journal of Obstetrics and Gynecology·Angel Paternina-CaicedoJosé A Rojas-Suarez
Jun 9, 2018·Journal of Thrombosis and Haemostasis : JTH·D D C A HenriquezJ G van der Bom
Oct 7, 2018·BMJ Quality & Safety·Daniel R MurphyHardeep Singh
Oct 3, 2019·NeoReviews·Ai-Ris Y Collier, Rose L Molina
Jun 1, 2019·PloS One·Aminu UmarMatthews Mathai
Jan 19, 2017·International Journal of Gynaecology and Obstetrics : the Official Organ of the International Federation of Gynaecology and Obstetrics·Abi MerrielJoanna Crofts
Feb 8, 2021·Journal of Obstetric, Gynecologic, and Neonatal Nursing : JOGNN·Samantha Bernstein
Dec 29, 2020·American Journal of Perinatology·Elizabeth A BlumenthalJennifer McNulty

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