Re:Any value of Early Warning Systems must rely on the prevalence of the conditions being sought
In reply to Bewley's response to our paper, we acknowledge that a number of studies have assessed the extent of major obstetric complications as higher than that cited in the RCOG publication [1-5]. Definitions as well as rate estimation of maternal morbidity vary widely across studies . However, the premise of our paper was not to minimise the scale and severity of the problem of maternal morbidity, but to explore the logic and perceived value of one particular safety solution, the MEOWS. In the light of our findings, we still conclude that the complexity of managing risk and safety within the maternity pathway, the associated opportunity costs of MEOWS and variation in implementation call into question its current role for routine use. We reiterate our belief that there is an urgent need for further research to validate the MEOWS for the maternity population.
References 1. Zhang WH, Alexander S, Bouvier-Colle MH, Macfarlane A; MOMS-B Group. Incidence of severe pre-eclampsia, postpartum haemorrhage and sepsis as a surrogate marker for severe maternal morbidity in a European population- based study: the MOMS-B survey. BJOG 2005;112:89-96. 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 3. Waterstone M, Bewley S, Wolfe C. Incidence and predictors of severe obstetric morbidity - a case control study. Br Med J 2001;322:1089-94 4. Brace, Victoria, Gillian Penney, and Marion Hall. Quantifying severe maternal morbidity: a Scottish population study. BJOG: An International Journal of Obstetrics & Gynaecology 2004;111:481-484 5. Zanconato, Giovanni, et al. Severe maternal morbidity in a tertiary care centre of northern Italy: a 5-year review. Journal of Maternal-Fetal and Neonatal Medicine 2012;25:1025-1028.
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