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Prioritizing Maternal Sepsis: National Adoption of an Obstetric Early Warning System to Prevent Morbidity and Mortality

Published:March 12, 2020DOI:https://doi.org/10.1016/j.jogc.2019.11.072

      Abstract

      Sepsis is one of the leading causes of maternal morbidity and mortality. Analyses have determined that delays in early recognition and prompt initiation of appropriate management are key contributing factors in maternal sepsis deaths. Recent cases of sepsis-related maternal morbidity and mortality across Canada have highlighted the urgent need for a national standardized approach to the detection and treatment of maternal sepsis. The SOGC has established a national multidisciplinary maternal sepsis task force to address this priority. The adoption of a national modified obstetric early warning system (MEOWS) is recommended as a key first step. This early warning scoring (EWS) system will facilitate early detection of maternal clinical deterioration and mandate timely escalation of care appropriate for the severity of illness. There is currently limited use of EWSs in Canada. Introducing a national EWS and a standardized maternal sepsis management guideline provides a tremendous opportunity to improve maternal care. A standardized approach will facilitate future evidence-based evaluation and refinement of the tool, and enable the reduction of preventable maternal morbidity and mortality from sepsis, as well as all causes duplicated.

      Résumé

      Le sepsis est l'une des principales de causes de morbidité et de mortalité maternelles. Des analyses ont déterminé que le retard de la détection précoce et du traitement rapide et adéquat constituent des facteurs contributifs importants des morts maternelles dues au sepsis. De récents cas de mortalité et de morbidité maternelles liés au sepsis partout au Canada ont mis en évidence le besoin urgent d'une démarche pancanadienne normalisée relative à la détection et au traitement du sepsis maternel. La SOGC a mis sur pied un groupe de travail multidisciplinaire pancanadien sur le sepsis maternel afin de s'attaquer à cette priorité. L'adoption d'un système obstétrical national d'avertissement précoce (Modified Early Obstetric Warning System ou MEOWS) a été recommandée comme première étape. Ce système d'avertissement précoce (SAP) facilitera la détection précoce de la détérioration clinique maternelle et établira une augmentation rapide des soins appropriés à la gravité de la maladie. À l'heure actuelle, l'utilisation du SAP est limitée. L’établissement du SAP et de directives cliniques normalisées sur le traitement du sepsis donne une occasion remarquable pour améliorer les soins maternels. Une démarche normalisée facilitera les futures évaluations fondées sur les données probantes et le raffinement des outils et permettra la réduction de la morbidité et de la mortalité maternelles évitables dues au sepsis de même que toutes les autres causes.

      Keywords

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      REFERENCES

        • Fleischmann C
        • Scherag A
        • Adhikari NK
        • et al.
        Assessment of global incidence and mortality of hospital-treated sepsis. current estimates and limitations.
        Am J Respir Crit Care Med. 2016; 193: 259-272
        • Say L
        • Chou D
        • Gemmill A
        • et al.
        Global causes of maternal death: a WHO systematic analysis.
        Lancet Glob Health. 2014; 2: e323-e333
        • Knight M, Tuffnell D, Kenyon S, Shakespeare J, Gray R, Kurinczuk JJ
        (Eds.) on behalf of MBRRACE-UK. Saving Lives, Improving Mothers' Care - Surveillance of maternal deaths in the UK 2011-3 and lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009-13.
        National Perinatal Epidemiology Unit, University of Oxford, Oxford2015
        • Singer M
        • Deutschman CS
        • Seymour CW
        • et al.
        The Third International Consensus definitions for sepsis and septic shock (Sepsis-3).
        JAMA. 2016; 315: 801-810
        • Kumar A
        • Roberts D
        • Wood KE
        • et al.
        Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock.
        Crit Care Med. 2006; 34: 1589-1596
        • 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.
        CEMACH, London, United Kingdom2007 (Available at:)
        • Ryan HM
        • Jones MA
        • Payne BA
        • et al.
        Validating the performance of the modified early obstetric warning system multivariable model to predict maternal intensive care unit admission.
        J Obstet Gynaecol Can. 2017; 39 (728–33.e3)
        • Singh S
        • McGlennan A
        • England A
        • et al.
        validation study of the CEMACH recommended modified early obstetric warning system (MEOWS).
        Anaesthesia. 2012; 67: 12-18
        • Shields LE
        • Wiesner S
        • Klein C
        • et al.
        Use of maternal early warning trigger tool reduces maternal morbidity.
        Am J Obstet Gynecol. 2016; 214 (527.e1–6)