Mackintosh et al. have made a useful contribution to the literature
about pregnant and parturient's safety (1). The purpose of an Early
Warning System (EWS) is to take action before deterioration that may
require multiorgan support in intensive care. The ethnographic technique
revealed many perceived benefits of a simple, graphic monitoring tool that
empowered escalation of concerns. The research team highlighted
inconsistencies in implementation of EWS, multiple competing charts for
antenatal, intrapartum, postnatal and high dependency care and also
resistance to medicalising normal birth. However, if EWSs do 'work'
(which may yet need proving), their value will also depend on the nature
and extent of problems which should not be understated.
The authors state "for every [maternal] death, nine women develop
major obstetric complications including haemorrhage, infection,
hypertensive disorders and thromboembolism". The RCOG reference cited is
itself in error as it reported the numbers of women in the UK utilising
critical care settings, (260 vs 14/ 100 000 maternities, a ratio of 19
high dependency and intensive care admissions to each death) (2). The
report explains how definitions of severe morbidity vary, but that the
number of major obstetric complications may be as high as 86-fold the
number of deaths (1 200/ 100 000 maternities) (2,3). EWSs may also have
an impact upstream on moderate morbidity with its commoner human and
financial costs.
References
1. Mackintosh N, Watson K, Rance S, Sandall J. Value of a modified
early obstetric warning system (MEOWS) in managing maternal complications
in the peripartum period: an ethnographic study. BMJ Qual Saf 2013;0:1-9.
doi:10.1136/bmjqs-2012-001781
2. Maternal Critical Care Working Group. Providing equity of critical
and maternity care for the critically ill pregnant or recently pregnant
woman. London: RCOG Press, 2011:4
Conflict of Interest:
None declared
Mackintosh et al. have made a useful contribution to the literature about pregnant and parturient's safety (1). The purpose of an Early Warning System (EWS) is to take action before deterioration that may require multiorgan support in intensive care. The ethnographic technique revealed many perceived benefits of a simple, graphic monitoring tool that empowered escalation of concerns. The research team highlighted inconsistencies in implementation of EWS, multiple competing charts for antenatal, intrapartum, postnatal and high dependency care and also resistance to medicalising normal birth. However, if EWSs do 'work' (which may yet need proving), their value will also depend on the nature and extent of problems which should not be understated.
The authors state "for every [maternal] death, nine women develop major obstetric complications including haemorrhage, infection, hypertensive disorders and thromboembolism". The RCOG reference cited is itself in error as it reported the numbers of women in the UK utilising critical care settings, (260 vs 14/ 100 000 maternities, a ratio of 19 high dependency and intensive care admissions to each death) (2). The report explains how definitions of severe morbidity vary, but that the number of major obstetric complications may be as high as 86-fold the number of deaths (1 200/ 100 000 maternities) (2,3). EWSs may also have an impact upstream on moderate morbidity with its commoner human and financial costs.
References
1. Mackintosh N, Watson K, Rance S, Sandall J. Value of a modified early obstetric warning system (MEOWS) in managing maternal complications in the peripartum period: an ethnographic study. BMJ Qual Saf 2013;0:1-9. doi:10.1136/bmjqs-2012-001781
2. Maternal Critical Care Working Group. Providing equity of critical and maternity care for the critically ill pregnant or recently pregnant woman. London: RCOG Press, 2011:4
Conflict of Interest:
None declared