Meeting Impending Medical Crises Head On During Pregnancy

Diane J. Angelini, EdD, CNM, FACNM, FAAN, NEA-BC

Early warning systems can facilitate timely recognition of deteriorating maternal status.

One way to enhance patient safety is to develop early warning systems for health status. The National Partnership for Maternal Safety has proposed a set of criteria for early recognition of abnormal parameters in obstetric patients. Two types of early warning systems were considered: a single-parameter system (triggered by abnormal status of any single physiologic parameter in a predefined list) or an aggregate-weighted scoring system (triggered by multiple parameters that require documentation and measurement to yield a final composite score).

The Subcommittee on Vital Signs chose the single-parameter system as it is viewed to be less cumbersome, given that most maternal problems often primarily involve abnormal vital signs. The subcommittee then generated the Maternal Early Warning Criteria, which include systolic and diastolic blood pressure, heart rate, respiratory rate, oxygen saturation, oliguria, maternal agitation, confusion, or unresponsiveness, and, in women with preeclampsia, unremitting headache or shortness of breath. Any pregnant woman who meets any of these criteria should receive prompt, urgent bedside evaluation and appropriate interventions initiated by a clinician with the capacity to escalate care as needed.

Citation(s):

Mhyre JM et al. The maternal early warning criteria: a proposal from the National Partnership for Maternal Safety. Obstet Gynecol 2014 Oct; 124:782.