Obstetric morbidity and mortality: Exploration of the use of Maternal Early Warning Scores (M-EWS) for recognition and escalated timely interventions in acute obstetric emergencies in Nigeria

Abstract

Severe Obstetric Emergencies: Use of Maternal Early Warning Scores (M-EWS) in Nigeria. Maternal Early Warning Scores (M-EWS) is a patient illness severity scoring system that aids tracking and timely escalation of acutely deteriorating obstetric patients. M-EWS has been demonstrated to reduce substandard care, obstetric complications, and maternal mortality in the United Kingdom and a number of other countries. Background: Successes in the prevention of maternal mortality attributed to this tool in the United Kingdom where it is in established use coupled with high potential for its usefulness in other countries prompted the inclusion of the M-EWS in the post 2015 United Nations Sustainable Development Goals for the 193 member nations. Aims: We set out to explore the availability of M-EWS for the recognition and escalated timely interventions in obstetric emergencies in Nigeria and a desire for its application. Methods: A combination of SurveyMonkey (online) and paper-based questionnaires distributed to clinicians of all teams and grades involved in obstetric care was used. Results: In all, 76 responses (17 online and 59 paper-based questionnaire) were received out of 30 e-mails and 70 paper-based questionnaires. Nineteen (25%) clinicians reported use of a physician-specific calling system but none had the M-EWS in use. Three respondents (4%) were not certain whether M-EWS would be welcomed in their service, but 73 (96%) welcomed the introduction of the M-EWS. Conclusion: This survey shows the lack of M-EWS in obstetric practice in Nigeria and strong desire for its introduction. Consequently, some collaborative work aimed at refining this tool for the Nigerian obstetric environment has commenced.