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Baseline assessment of a hospital‐specific early warning trigger system for reducing maternal morbidity
Author(s) -
Hedriana Herman L.,
Wiesner Suzanne,
Downs Brenda G.,
Pelletreau Barbara,
Shields Laurence E.
Publication year - 2016
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1016/j.ijgo.2015.07.036
Subject(s) - medicine , eclampsia , intensive care unit , pregnancy , retrospective cohort study , sepsis , emergency medicine , maternal morbidity , obstetrics , genetics , biology
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.