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Reduction of Maternal Mortality in Ghana: Is an Obstetric Early Warning System the answer?
Abstract Number: T-01
Abstract Type: Original Research
Background: The early detection of severe illness in obstetric patients is challenging. Physiologic deterioration is often evident six to eight hours before cardiopulmonary arrest, but the warning signs of deterioration can go undetected . The United Kingdom’s Centre for Maternal and Child Enquiries has recommended that all hospitals utilize a modified early warning scoring system to improve care . Ridge Regional Hospital in Accra, Ghana has approximately 9000 deliveries per year and had 45 maternal deaths in 2014. Currently there is not an early warning scoring system in use at Ridge Hospital, but the implementation of such a system has the potential to decrease adverse maternal outcomes.
Methods: We performed a retrospective review of the maternal deaths in 2014 to determine if an early warning scoring system could be applicable in a low resource environment. Severe vital sign parameters were locally defined by the departments of obstetrics and anesthesia: SBP>200 or <80, HR>140, SpO2<90%, RR>40 and any change in consciousness. Of the 43 charts that were available for review, 37 patients or 86% had vital signs in the severe range that were present on average 40 hours prior to death. None of the charts had documentation of the bedside nurse’s response to the severe vital sign recorded and 100% of charts had poor dating and timing of physician notes. This precluded analysis of the time span between abnormal parameters and physician review and intervention. Ridge Hospital’s local audit committee identified 49% of the charts as lacking adequate documentation.
Conclusion: The majority of deaths in this low resource setting demonstrated early evidence of severe vital signs that required early intervention. Delay or absence of intervention often led to poor outcome. A standardized protocol that initiates an expedited communication to senior help is nonexistent. Furthermore, no standardized method of documentation exists. A Modified Early Obstetric Warning Score is an example of a system that can be beneficial by 1) ensuring proper documentation of vital signs and interventions 2) linking abnormal vital sign parameters to specified intervention and 3) eliminating delay in seeking more experienced help of senior physicians.
1. Franklin, C., et al. Developing strategies to prevent in hospital cardiac arrest:analyzing responses of physicians and nurses in the hours before the event. Crit Care Med,1994.
2.McClure, J.H., et al.,Saving mothers' lives: reviewing maternal deaths to make motherhood safer: 2006-8:Br J Anaesth, 2011.