Motherhood and the Early Response Algorithm

By Kristine Hartvigsen on May 14th, 2017

Over time, experienced moms develop their own informal algorithms to prevent unwanted complications with their young ones. These internal systems help them decide whether or not they must immediately spring into action or continue making sandwiches.

For example, a toddler wants to wear cowboy boots and a Darth Vader costume to preschool. The mother’s mind goes through a series of pull-down menus:  Is it Halloween? No. Does the preschool have a flexible dress code? Yes. Is the ensemble compatible with the weather? Yes. Will wearing this outfit put my child’s life at risk? No.

Later that morning, as she waves goodbye to her diminutive dark lord, she has successfully avoided an exhaustive, time-consuming conflict with a determined child who is historically inclined to tantrum. She also has met her maternal obligation to keep her child alive.

On a more serious note, quick decision-making in the clinical sphere, likewise, is best achieved using a well-researched, fully vetted algorithm. Fortunately, hospitals across the nation are utilizing Maternal Early Warning Systems (MEWS) to ensure that rapid, life-saving intervention are taken should a medical crisis arise in the Labor and Delivery unit.

Studies have estimated that nearly half of maternal deaths in the United States are preventable and most likely the result of delays in recognition and treatment of hemorrhage, hypertension, infection, and venous thrombosis. In an effort to reduce maternal mortality, a panel of experts with the National Partnership for Maternal Safety identified a list of parameters to signal when urgent evaluation and escalation of care are needed. Characteristics the group recognized for its MEWS include:

• systolic BP  <90 or >160
• diastolic BP  >100
• heart rate; beats per minute  <50 or >120
• respiration; breaths per minute  <10 or >30
• oxygen saturation  <95%
• oliguria (low urine output); <30 mL
• maternal agitation, confusion, or unresponsiveness
• non-remitting headache or shortness of breath

A healthcare worker noticing that a patient is exhibiting abnormal vitals under these parameters must immediately report it to a senior physician or qualified clinician, who then should promptly conduct a bedside evaluation of the patient. At that time, any necessary emergency diagnostic and therapeutic interventions would be made.

A 2014 evaluation of the MEWS utilized at Columbia University Medical Center in New York found that the majority of alerts at CUMC — 80% — were from indications of:

• oliguria (low urine output), which can suggest renal failure or acute kidney injury
• severe hypertension
• tachycardia (abnormally fast heart rate)

It is fitting that National Women’s Health Week, May 14-20, 2017, begins on Mother’s Day. This year, we spotlight the MEWS as just one tool in our arsenal to ensure that pregnant women may have successful deliveries and enjoy many years of happy Mother’s Days.

This blog provides general information and discussion about healthcare-related subjects. The content and linked materials provided are not intended and should not be construed as medical advice. If the reader is an expectant mother with a medical concern, she should consult with an appropriately licensed physician or healthcare provider.


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