Published August 2, 2022
Early warning criteria are associated with increased odds of severe postpartum morbidity and mortality
A woman’s risk of severe maternal morbidity and mortality does not end when a pregnancy ends. In fact, approximately 18% of severe maternal morbidity, which results in significant short- or long-term consequences to maternal health, and about 33% of maternal deaths occur in the postpartum period.
Because healthcare providers may not identify a woman as postpartum if she is no longer visibly pregnant or does not mention a recent delivery – or may neglect to recognize the unique changes in a women’s body that persist for at least six weeks after delivery – opportunities can be missed to address problems early. Providers may also lack the right tools to identify and treat high-risk postpartum patients.
Maternal early warning criteria (MEWC) have been accepted by the National Partnership for Maternal Safety to identify obstetric patients at high risk for severe maternal morbidity and mortality. When applied during post-birth hospitalization, they help clinicians recognize conditions that could lead to severe negative outcomes. However, it is not yet known if MEWC are an effective way to predict adverse events in the postpartum period.
An Ochsner research team led by Jane Martin, MD, a second-year Maternal-Fetal Medicine Fellow; Cruz Velasco-Gonzalez, PhD, Senior Biostatistician; Mariella Gastanaduy, PhD, Epidemiologist; John Morgan, MD, Maternal-Fetal Medicine Fellow; Will Williams, MD, Maternal-Fetal Medicine physician; Joseph Biggio, MD, System Chair of Women’s Services and Maternal-Fetal Medicine; plus several UQ Ochsner Clinical School medical students, sought to find out.
Using data from patients who received care within the Ochsner Health system from January 1, 2013, to September 1, 2020, the researchers studied women who experienced severe maternal morbidity or died in the time between their hospitalization and 42 days postpartum.
MEWC were strongly associated with subsequent severe outcomes. Their presence alone predicted 78% of postpartum severe maternal morbidity and deaths and – when included in a model that adjusted for race, BMI and cesarean delivery – 90% of severe outcomes were predicted. Their study also found that black women experienced 93% higher odds of severe postpartum outcomes than white women.
