Original Article Early detection of severe maternal morbidity: A retrospective assessment of the role of an Early Warning Score System Diana M. AUSTIN, 1 Lynn SADLER, 1 Claire MCLINTOCK, 1 Colin MCARTHUR, 1 Vicki MASSON, 2 Cindy FARQUHAR 2 and Sharon RHODES 1 1 Auckland District Health Board, and 2 University of Auckland, Auckland, New Zealand Background: The Early Warning Scoring (EWS) surveillance system is used to identify deteriorating patients and enable appropriate staff to be called promptly. However, there is a lack of evidence that EWS surveillance systems lead to a reduction in severe morbidity. Aims: To determine whether as EWS may have improved the detection of severe maternal morbidity or lessened the severity of illness among women with severe morbidity at a large tertiary maternity unit at Auckland City Hospital (ACH), New Zealand. Methods: Admissions to intensive care, cardiothoracic and vascular intensive care, or an obstetric high-dependency unit (HDU) were identified from clinical and hospital administrative databases. Case reviews and transcribed observation charts were presented to a multidisciplinary review group who, through group consensus, determined whether an EWS might have hastened recognition and/or escalation and effective treatment. Results: The multidisciplinary review team determined that an EWS might have reduced the seriousness of maternal morbidity in five cases (7.6%), including three admissions for obstetric sepsis to intensive care unit and two to obstetric HDU for post-partum haemorrhage. No patient had a complete set of respiratory rate, heart rate, blood pressure and temperature recordings at every time period. Conclusions: These findings have been used to support introduction of an EWS to the maternity unit at ACH. Key words: early warning score, maternal morbidity, surveillance systems. Introduction The Early Warning Scoring (EWS) surveillance system is typically based on data derived from physiological observations (e.g systolic blood pressure, heart rate, respiratory rate, body temperature, level of consciousness). The observations are compared to a normal range to generate a single composite score, which is used to ‘guide’ appropriate clinical care. The original EWS ‘was designed solely to secure the timely presence of skilled clinical help by the bedside of those patients exhibiting physiological signs compatible with established or impending critical illness’ rather than as a predictor of poor outcome. 1 The UK review of maternal deaths ‘Saving Mothers’ Lives’ 2 recommends the routine use of a national Modified Early Obstetric Warning Score (MEOWS) chart in all pregnant or post-partum women who become unwell to facilitate more timely recognition, referral and treatment of women who have, or are developing, a critical illness. The same recommendation is presented more recently by The Maternal Critical Care Working Group. 3 There is a lack of evidence that such EWS systems lead to a reduction in severe morbidity. 4 The Australian MERIT 5 study randomised 23 hospitals either to introduce a Medical Emergency Teams (MET) system that included ‘physiological calling criteria’ or to maintain the status quo. Investigators found that while the emergency teams were called more frequently when ‘calling criteria’ were used, there was no reduction in the incidence of cardiac arrest, unplanned intensive care unit (ICU) admissions or unexpected death. Auckland City Hospital (ACH) is a large tertiary general hospital in Auckland, New Zealand, with tertiary level obstetric and neonatal services, birthing approxi- mately 7500 women per year. At ACH, severely ill adults (>15 years of age) will be managed in the ICU or Correspondence: Mrs Diana M. Austin, Auckland District Health Board – Womens Health, Auckland City Hospital Private Bag 92024 Auckland Mail Centre, Auckland 1142, New Zealand. Emails: dianaa@adhb.govt.nz and lp.dm.austin@clear.net.nz Received 1 July 2013; accepted 23 October 2013. 152 © 2013 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists Australian and New Zealand Journal of Obstetrics and Gynaecology 2014; 54: 152–155 DOI: 10.1111/ajo.12160 Te Australian and New Zealand Journal of Obstetrics and Gynaecology