The deteriorating pregnant patient

Whilst it is recognised that pregnancy and labour are normal physiological events, observation of vital signs is important and should form an integral part of care. There is a potential for any woman to be at risk of physiological deterioration and this can not always be predicted. There is also evidence that there is poor recognition of the deteriorating pregnant patient (1).

The early detection of severe illness in mothers remains a challenge to all professionals involved in their care. The relative rarity of such events combined with the normal changes in physiology associated with pregnancy and childbirth compounds the problem.

For example changes in physiological observations in pregnancy might include:

  • Heart increase of 15-20 bpm
  • Respiratory Rate increase of 2 breaths per minute
  • Blood Pressure decrease of 10mm Hg

Regular recording and documentation of vital signs can aid recognition of any change in a woman’s condition. The use of MEOWS charts prompts early referral to an appropriate practitioner who can undertake a full review, order appropriate investigations, resuscitate, and treat as required (2).

Physiological track and trigger systems should be used to monitor all antenatal and postnatal admissions. There are a number of charts in use nationally that take into account physiological changes that occur in parameters measured, such as blood pressure and respiratory rate. There is not currently, however, a validated chart for use in pregnancy (3). Banfield and Roberts discuss the challenges with agreeing upon a pregnancy specific chart and also highlight the approach taken for the earlier recognition of sepsis in pregnancy. (LINK TO ARTICLE) Following labour and delivery, physiological observations should be monitored at least every 12 hours, unless a decision has been made at a senior level to increase or decrease this frequency for an individual patient or group of patients (3).

It is equally important that these charts are also used for pregnant or postpartum women who are unwell and are being cared for outside obstetric and gynaecology services e.g. Emergency Departments. Abnormal scores should not just be recorded but should also trigger an appropriate response (4).

References:

  1. 1. Lewis G, editor; The Confidential Enquiry into Maternal and Child Health (CEMACH). Saving Mothers' Lives: Reviewing Maternal Deaths to make Motherhood Safer—2003–2005. The Seventh Report on Confidential Enquiries into Maternal Deaths in the United Kingdom. London: CEMACH; 2007.

  2. Breslin A. The Royal Free Maternity Guidelines: MEOWS guidance in maternity, 2009. http://www.oaa-anaes.ac.uk/assets/_managed/editor/File/Guidelines/MEOWS/Royal%20Free%20MEOWS%20Guideline%20-%20McGlennan_.pdf Accessed on 2nd February, 2015

  3. Providing equity of critical and maternity care for the critically ill pregnant or recently pregnant woman. July 2011. http://www.rcoa.ac.uk/system/files/CSQ-ProvEqMatCritCare.pdf Accessed on 2nd February, 2015

  4. Centre for Maternal and Child Enquiries (CMACE). 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 2011;118(Suppl. 1):1–203.
    http://www.cdph.ca.gov/data/statistics/Documents/MO-CAPAMR-CMACE-2006-08-BJOG-2011.pdf

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