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///2018 Abstract Details
2018 Abstract Details2019-08-02T15:57:01-05:00

The National Partnership for Maternal Safety Recommended Maternal Early Warning Criteria are Associated with Maternal Morbidity

Abstract Number: O1-1
Abstract Type: Original Research

David E Arnolds MD, PhD1 ; Aaron Smith BA2; Barbara M Scavone MD3

Background: Maternal mortality and severe obstetric morbidity are devastating, increasing, and preventable (1, 2). Recognition that complications may result from a delayed response to warning sings has prompted efforts to identify vital signs that alert clinicians to impending morbidity and allow for potentially life-saving interventions. The National Partnership for Maternal Safety has proposed the use of the Maternal Early Warning Criteria (MEWC) for this purpose (3). The MEWC were devised by an expert committee and their relationship to maternal morbidity has not been studied. The goal of our study was to evaluate the correlation between the MEWC and maternal morbidity.

Methods: We retrospectively reviewed the first 400 deliveries of 2016 at our institution. Vital signs were used to determine if patients triggered MEWC. Morbidity was defined using minor modifications to published criteria (4). We calculated the sensitivity, specificity, PPV, and NPV of the MEWC as well as the relative risk of each component with maternal morbidity. The association between MEWC and morbidity was tested using γ2 analysis.

Results: 281 of 400 patients (70%) triggered the MEWC. The most common trigger was SpO2<95% (Table). 99 of 400 patients (25%) experienced morbidity. Hemorrhage (41%), suspected infection (31%), and severe preeclampsia (19.5%) accounted for 91.5% of morbidity. 96 of 99 patients experiencing morbidity triggered the MEWC, yielding a sensitivity of 0.97. 185 patients triggered the MEWC but did not experience morbidity, yielding a specificity of 0.39. The PPV of the MEWC was 0.34 and the NPV was 0.97. The relative risk of maternal morbidity was greatest for T>38.5 C and least for SBP<90 (Table). Triggering the MEWC was significantly associated with morbidity (p<0.0001).

Conclusions: The MEWC are sensitive but not specific. While screening tools are appropriately biased towards sensitivity, a PPV of 0.34 and trigger rate of 70% suggest that the MEWC may not be clinically useful in its current form. The wide range of vital signs experienced in labor makes identifying pathology based on isolated vital signs challenging, whereas identifying sustained abnormal patterns may be effective (5). Further research is necessary to identify optimal strategies to alert clinicians to women at risk of impending morbidity.

1.Creanga: Obstet Gynecol 2015

2.Main: Obstet Gynecol 2015

3.Mhyre: Obstet Gynecol 2014

4.Singh: Anaesthesia: 2011

5.Shields: Am J Obstet Gynecol 2016

SOAP 2018