Baseline assessment of a hospital-specific early warning trigger system for reducing maternal morbidity. Issue 3 (March 2016)

• Record Type: Journal Article
• Authors: Hedriana, Herman L.; Wiesner, Suzanne; Downs, Brenda G.; Pelletreau, Barbara; Shields, Laurence E.
• Is Part Of: International journal of gynaecology and obstetrics. Volume 132:Issue 3(2016:Mar.)
• Page Start: 337
• Page End: 341
• Publication Date: 2016-03
• Subjects: Early warning triggers -- ICU admissions -- Maternal morbidity; Gynecology -- Periodicals; Obstetrics -- Periodicals; Electronic journals; 618
• DOI: 10.1016/j.ijgo.2015.07.036
• Languages: English
• ISSNs: 0020-7292

Abstract

Abstract: Objective: To determine whether predefined maternal early warning triggers (MEWTs) can predict pregnancy morbidity. Methods: 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. Results: 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. Conclusion: Persistent MEWTs were present in most obstetric ICU cases. Retrospectively, MEWTs in this cohort seemed to separate normal obstetric patients from those for whom ICU admission was indicated; their use might reduce maternal morbidity.