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. 2019 Jan;98(1):7-10.
doi: 10.1111/aogs.13448. Epub 2018 Oct 16.

Modified early obstetric warning scores: A promising tool but more evidence and standardization is required

Tanya Robbins  1 , Andrew Shennan  1 , Jane Sandall  1
Affiliations

Modified early obstetric warning scores: A promising tool but more evidence and standardization is required

Tanya Robbins et al. Acta Obstet Gynecol Scand. 2019 Jan.

Abstract

Early warning systems involve the routine monitoring and recording of vital signs or clinical observations on specifically designed charts with linked escalation protocols. Meeting criteria for abnormal physiological parameters triggers a color-coded or weighted scoring system aimed to guide the frequency of monitoring, need for, and urgency of clinical review. Color-coded systems trigger a clinical response when one or more abnormal observation is recorded in the red zone or two or more mildly abnormal parameters in the amber zone. The principle of maternity-specific early warning systems to structure surveillance for hospitalized women is intuitive. The widespread use and policy support, including recommendations following confidential enquiries and from the National Health Service Litigation Authority, is not, however, currently backed up by a strong evidence base. Research is required to develop predictive models and validate evidence-based maternity-specific early warning systems in the general maternity population.

Keywords: early warning system; morbidity; mortality; pregnancy.

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Conflict of interest statement

AS has developed an automated vital signs monitoring device (CRADLE Vital Signs Alert) with Microlife, incorporating a traffic light triage system. AS is principle investigator on the ongoing CRADLE Projects. JS is co‐investigator on the CRADLE 3 trial.

References

    1. Knight M, Nair M, Tuffnell D, On behalf of MBRRACEUK. Surveillance of Maternal Deaths in the UK 2012–14 and Lessons Learned to Inform Maternity Care from the Uk and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009–14. Oxford, UK: MBRRACE; 2016.
    1. WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division . Trends in Maternal Mortality 1990. –2015. Geneva, Switzerland: WHO.
    1. Lewis G, Clutton‐Brock T, Cooper G, et al. Saving Mothers' Lives: Reviewing maternal Deaths to Make Motherhood Safer 2003‐2005. London, UK: CEMACH; 2007.
    1. Royal College of Physicians . National Early Warning Score (News): Standardising the Assessment of Acute‐Illness Severity in the NHS. London, UK: : RCP; 2012.
    1. Kumar F, Kemp J, Edwards C, et al. Pregnancy physiology pattern prediction study (4P study): protocol of an observational cohort study collecting vital sign information to inform the development of an accurate centile‐based obstetric early warning score. BMJ Open. 2017;7:e016034. - PMC - PubMed

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