Case reviews of maternal death have revealed a concerning pattern of delay in recognition of hemorrhage, hypertensive crisis, sepsis, venous thromboembolism, and heart failure. Early-warning systems have been proposed to facilitate timely recognition, diagnosis, and treatment for women developing critical illness. A multidisciplinary working group convened by the National Partnership for Maternal Safety used a consensus-based approach to define The Maternal Early Warning Criteria, a list of abnormal parameters that indicate the need for urgent bedside evaluation by a clinician with the capacity to escalate care as necessary in order to pursue diagnostic and therapeutic interventions. This commentary reviews the evidence supporting the use of early-warning systems and describes The Maternal Early Warning Criteria, along with considerations for local implementation.
The Maternal Early Warning Criteria may be used to identify patients who may benefit from urgent bedside medical evaluation.Supplemental Digital Content is Available in the Text.
Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas; the Central Jersey Family Health Consortium, Inc., North Brunswick, New Jersey; the Departments of Cardiology and Maternal-Fetal Medicine, University of California, Irvine, Irvine, California; the Department of Reproductive Biology, Case Western Reserve University School of Medicine and the Department of Obstetrics and Gynecology, University Hospitals Case Medical Center, Cleveland, Ohio; the School of Nursing, Vanderbilt University, Nashville, Tennessee; the Department of Obstetrics and Gynecology, Maternal-Fetal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa; the Department of Obstetrics and Gynecology, Rush University Medical Center, Chicago, Illinois; the Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Women's Health, University of Louisville, Louisville, Kentucky; and the Department of Obstetrics & Gynecology, Maternal-Fetal Medicine, Columbia University Medical Center, New York, New York.
Corresponding author: Jill M. Mhyre, MD, Department of Anesthesiology, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 515, Little Rock, AK 72205; e-mail: firstname.lastname@example.org
This article is being published concurrently in the November/December 2014 issue (Vol. 43, No. 6) of Journal of Obstetric, Gynecologic, & Neonatal Nursing.
Presented at the Annual Clinical Meeting of the American College of Obstetricians and Gynecologists on May 5, 2013, in New Orleans, Louisiana, and as part of two webinars for the Hospital Engagement Network on August 8, 2013, and March 17, 2014.
The authors thank Janet A. Meyers, RN, MPH, from The Hospital Corporation of America and Tammy L. Witmer, CNM, MSN, from The Reading Health Physician Network Reading Birth Center for serving as subcommittee members and contributing to the consensus document.
Financial Disclosure The authors did not report any potential conflicts of interest.