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A modified early obstetric warning system

02 December 2014
Professional
02 December 2014
Volume 22 · Issue 12

Abstract

Early warning scoring tools are embedded in the routine care of most hospitalised patients in the NHS. The underlying principles are that patients who develop serious illness will usually display abnormalities in simple physiological parameters and that if these early signs are recognised and appropriate escalation and intervention occurs, patient outcomes will be improved. Constructing a system for use in childbearing women presents a unique set of challenges. This article details how the national early warning scoring system can be adapted and used in the routine care of hospitalised pregnant and postnatal women.

For the majority of women childbearing is a normal life event. Physiological adaptations usually ensure a woman has a healthy pregnancy, childbirth and postnatal recovery. However, the increased cardiovascular reserves and other physiological changes in childbearing women can mask the sometimes inconspicuous signs of severe maternal illness. This can make recognition of impending maternal collapse difficult. ‘Women with serious illness, especially sepsis, may appear deceptively well before suddenly collapsing, often with little or no warning’ (Centre for Maternal and Child Enquiries (CMACE), 2011: 86). In addition, maternal wellbeing may be compromised in women of increased maternal age, obese women or women with complex medical conditions (Lee, 2014).

It is important that midwives have the necessary effective tools available to aid clinical assessment and judgement when managing potentially life-changing complications in childbearing women.

Early warning scoring systems have been developed nationally following recognition and evidence that physiological abnormalities precede critical illness (Cullinane et al, 2005).

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Postpartum period
Assessment
Severity of illness index
Vital signs
Pregnancy complications