Physiological track‐and‐trigger/early warning systems for us | Figure 1

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Physiological track‐and‐trigger/early warning systems for use in maternity care

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Is using simple monitoring tools helpful in alerting to clinical problems and in reducing serious illness or death in pregnant women and in their first 6 weeks after birth?

Many natural functional changes occur in a woman's body during pregnancy. As a result, a pregnant woman, who may appear healthy and well, can become rapidly very sick. If not detected sufficiently early and treated successfully, the pregnant woman can become seriously ill or even die. Examples are serious bleeding and serious infection. Simple bedside tools or charts can be used by maternity care providers (midwives and doctors) to record information on a woman's health. The recorded health measures include her blood pressure, pulse rate, breathing rate, temperature, and other health measures such as mental alertness. The tools have been introduced so that the measures are observed, recorded and interpreted together, rather than as single measures. The aim is to detect when serious illness is, or might be developing. Medical staff can then step in to prevent serious harm.

We found 2 studies that compared an early warning system with standard care. One involved 700 women and the second was a stepped‐wedge cluster trial involving 536,233 women. Different clusters of centres introduced the tool over time until all centres were using it. Both studies were carried out in low‐resource settings. The tools were called the 'Saving Mothers Score' (SMS) and the CRADLE Vital Sign Alert (VSA) device.

We found the tools probably do not reduce maternal death. Women may have less serious bleeding (or haemorrhage) when an early warning tool is used (low‐certainty evidence). The tools may make little or no difference to a potentially life‐threatening sepsis, to blood pressure with swelling, protein in the urine and convulsions (eclampsia), to a serious illness in pregnancy that affects the blood and the way the liver works (HELLP), or being admitted to an intensive care unit (ICU). Use of the tools probably reduces the time a woman stays in hospital (moderate‐certainty evidence). The tools may make little or no difference to the death of the baby in the first month after birth (low‐certainty evidence).

More studies are required on the different early warning systems. Studies are also needed in middle‐ and high‐resource settings, and in high‐ and low‐risk pregnant women.

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