Implementation of a maternal early warning system during early postpartum. A prospective observational study

Area of Science:

• Obstetrics and Gynecology
• Patient Safety
• Health Informatics

Background:

• Postpartum complications pose significant risks to maternal health.
• Effective monitoring systems are crucial for early detection and intervention.
• The maternal early warning system (MEWS) is designed to identify at-risk patients post-delivery.

Purpose of the Study:

• To evaluate the implementation and effectiveness of a maternal early warning system (MEWS) in a tertiary hospital.
• To assess the system's performance in monitoring patients during the initial two hours after delivery.

Main Methods:

• A prospective evaluation of MEWS implementation involving 1166 patients over six months.
• Collection of vital signs, urine output, uterine status, and bleeding.
• Sensitivity-specificity analysis of MEWS triggers and multivariate analysis of factors related to adverse outcomes.

Main Results:

• The MEWS triggered in 6.43% of patients, with altered systolic blood pressure being the most common trigger.
• The system demonstrated low sensitivity (0.28) and high specificity (0.94).
• A significant number of false-negatives (28) were identified, indicating missed critical cases.

Conclusions:

• The implemented MEWS has high specificity but low sensitivity, indicating a substantial rate of false-negatives.
• The system's current performance suggests a need for improvement to enhance early detection of potentially fatal disorders.
• Further research is warranted to optimize MEWS parameters for improved postpartum patient safety.