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Irish Maternal Early Warning Score

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Early Warning Systems (EWS) track the physiological parameters of individual patients and trigger a response when the parameter threshold has been reached. The use of early warning scores in adult hospital medicine has been shown to be beneficial in facilitating the early recognition of the deteriorating patient, thereby enabling prompt treatment. In 2012, a standardised National Early Warning Score was introduced in Ireland for all non-pregnant patients. The 2007 Confidential Enquiry into Maternal and Child Health recommended that EWS be introduced into maternity practice. However, the unique physiological changes of pregnancy even in health means that any scoring system must be specially adapted. The Obstetric Early Warning Score (OEWS) aims to promote early recognition of the pregnant patient at risk of deterioration. In 2013, a standardised Irish Maternity Early Warning System (IMEWS) was introduced nationally. However, the scoring system is only part of the package, once triggered it needs to be effectively communicated and acted upon promptly by appropriately trained clinicians. Despite undoubted shortcomings, the international evidence to date is supportive of the beneficial role of the OEWS in preventing maternal morbidity. Further research is needed to improve the sensitivity and specificity of the OEWS and how to better integrate it into every-day clinical practice.

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  1. Centre for Maternal and Child Enquiries (CMACE) (2011) Saving mothers’ lives: reviewing maternal deaths to make motherhood safer: 2006–08. The eighth report on confidential enquiries into maternal deaths in the United Kingdom. BJOG 118(Suppl. 1:1–203

    Google Scholar 

  2. Nelligan PJ, Laffey JG (2011) Clinical review: critical care in pregnancy. Crit Care 15:1014

    Article  Google Scholar 

  3. Knight M, Nair M, Tuffnell D, Kenyon S, Shakespeare J, Brocklehurst P, Kurinczuk JJ, on behalf of MBRRACE-UK. Saving lives, improving mothers’ care - surveillance of maternal deaths in the UK 2012–14 and lessons learned to inform maternity care from the UK and Ireland con dential enquiries into maternal deaths and morbidity 2009–14. Oxford: National Perinatal Epidemiology Unit, University of Oxford 2016

    Google Scholar 

  4. Goldhill DR, White SA, Sumner A (1999) Physiological values and procedures in the 24 h before ICU admission from the ward. Anaesthesia 54:529–534

    Article  CAS  Google Scholar 

  5. Maternal Death Enquiry Ireland (2012) Confidential maternal death enquiry in Ireland: report of the triennium 2009–2011. MDE, Cork

    Google Scholar 

  6. McGaughey J, Alderdice F, Fowler R et al (2007) Outreach and early warning systems (EWS) for the prevention of intensive care admission and death of critically ill adult patients on general hospital wards. Cochrane Database Syst Rev 3:CD005529

    Google Scholar 

  7. Isaacs R, Wee MYK, Bick D et al (2014) A national survey of obstetric early warning systems in the United Kingdom: five years on. Anaesthesia. 69:678–692

    Article  Google Scholar 

  8. Smith ME, Chiovaro JC, O’Neil M et al (2014) Early warning system scores for clinical deterioration in hospitalised patients: a systematic review. Ann Am Thorac Soc 11:1454–1465

    Article  Google Scholar 

  9. National Early Warning Score (NEWS) (2014) Standardising the assessment of acute illness severity in the NHS. Royal College of Physicians, London

    Google Scholar 

  10. Carle C, Alexander P, Columb M, Johal J (2013) Design and internal validation of an obstetric early warning score: secondary analysis of the intensive care national audit and research centre case mix programme database. Anaesthesia. 68(4):354–367

    Article  CAS  Google Scholar 

  11. Lewis G (ed) (2007) Saving Mothers’ Lives: Reviewing Maternal Deaths to Make Motherhood Safer 2003–2005. The seventh report on confidential enquiry into maternal deaths in the United Kingdom. CEMACH, London

    Google Scholar 

  12. Institute of Obstetricians and Gynaecologists. Royal College of Physicians of Ireland. The Irish Maternity Early Warning System (I-MEWS). Accessed 21 Aug 2018

  13. Maguire PJ, O'Higgins AC, Power KA, Daly N, McKeating A, Turner MJ (2015) Maternal bacteremia and the Irish Maternity Early Warning System. Int J Gynaecol Obstet 129(2):142–145

    Article  Google Scholar 

  14. Maguire PJ, Power KA, Daly N, Farren M, McKeating A, Turner MJ (2016) High dependency unit admissions during the first year of a national obstetric early warning system. Int J Gynaecol Obstet 133(1):121–122

    Article  Google Scholar 

  15. Singh S, Mc Glennan A, England A et al (2012) A validation study of the CEMACH recommended modified early obstetric warning system (MEOWS). Anaesthesia. 67(1):12–19

    Article  CAS  Google Scholar 

  16. Edwards S, Grobman W, Lappen J et al (2013) Modified early obstetric warning systems (MEOWS): diagnostic performance for severe sepsis in women with chorioamnionitis. BJOG Int J Obstet Gynaecol 120:456–457

    Article  Google Scholar 

  17. Paternina- Caicedo A, Miranda J, Bourjeily G et al (2017) Performance of the Obstetric Early Warning Score in critically ill patients for the prediction of maternal death. Am J Obstet Gynecol 216:58. e1–58. e8

    Article  Google Scholar 

  18. Shields LE, Wiesner S, Klein C, Pelletreau B, Hedriana HL (2016) Use of maternal early warning trigger tool reduces maternal morbidity. Am J Obstet Gynaecol 214:527.e1–527.e6

    Article  Google Scholar 

  19. Manning E, Leitao S, Corcoran P, McKernan J, de Foubert P, Greene RA, on behalf of the Severe Maternal Morbidity Group (2018) Severe maternal morbidity in ireland annual report 2016. National Perinatal Epidemiology Centre, Cork

    Google Scholar 

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Correspondence to Shrijit Nair.

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figure a

An example of an Obstetric Early Warning Score (OEWS) chart, the Irish Maternity Early Warning System (IMEWS).

Appendix 2

figure b

Irish Maternity Early Warning System (IMEWS) escalation policy

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Nair, S., Spring, A., Dockrell, L. et al. Irish Maternal Early Warning Score. Ir J Med Sci 189, 229–235 (2020).

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