1. Killion, Molly M. MS, RN, CNS

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Early warning systems are safety algorithms that consider data points that may include changing vital signs, laboratory values, and clinical assessment to assess a patient's risk of a poor outcome and trigger health care providers of a potential danger. Many of these early warning systems have been in use for decades and have been shown to predict severe morbidity and mortality in the nonobstetric population (Zuckerwise & Lipkind, 2017). Although maternal early warning signs algorithms specific to the obstetric population are newer, they have also been shown to effectively predict women at risk for maternal morbidity (Arnolds et al., 2019). Maternal mortality in the United States continues to be a large problem with a higher rate than other developed nations. The rate has increased and it is thought that at least half of these deaths may have been preventable (Zuckerwise & Lipkind).


Predicting and preventing in-hospital deaths is an important step in decreasing maternal morbidity and mortality, yet many adverse events also happen outside of the hospital. The underlying disease processes that can cause poor outcomes have often begun to cause symptoms at home that may appear mild and less worrisome, delaying seeking medical care. Earlier recognition and intervention could potentially help to prevent injury or death. In 2018, the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) released an education program that targets "post-birth warning signs" including online education for nurses with information on maternal morbidity and mortality and effective techniques to disseminate information to patients to recognize warning signs. There are patient handouts for discharge teaching available in English, Spanish, Arabic, and Chinese targeting recognition of postpartum danger signs split into easy to understand symptoms that represent emergency issues (pulmonary embolus, eclampsia, suicidal/homicidal ideation) and urgent issues (bleeding, infection, deep vein thrombosis, preeclampsia). Symptoms are separated by the level of help needed; calling 911 versus calling a health care provider (AWHONN).


In May 2020, the Council on Patient Safety in Women's Health Care (2020) released an Urgent Maternal Warning Signs program to help patients recognize active or impending adverse effects requiring medical attention. A handout is available in English and Spanish, reviews systems from head-to-toe, and covers many of the common causes of maternal morbidity and mortality including hemorrhage, hypertensive conditions, infection, and thromboembolisms from antepartum through postpartum. It lists each warning sign and includes expanded information to describe the concerning factors of each symptom with an option for patients to click "more information" for additional details and then finally a "more resources" section that leads the patient to different websites or resources for the disease or condition represented by the symptom. It allows patients to discover as much or as little feels right to them to examine symptoms and concerning findings to see if it may represent how they are feeling. Both the AWHONN and Urgent Maternal Warning Signs information sheets remind women to disclose to first responders or health care providers that they are pregnant or have recently had a baby so they can get the proper level of care and consideration. Both resources are free to use for patient education.


Empowering women to listen to their own bodies and recognize when changes are occurring that may require urgent medical attention, while also having a health care team ready to listen to women, are critically important steps in reducing maternal morbidity and mortality. Using effective and easily understood information to teach patients and available for them to use as a quick resource in their native language once home can be powerful tools in the pursuit to keep women safe and healthy during pregnancy, labor, birth, and postpartum.




Arnolds D. E., Smith A., Banayan J. M., Holt R., Scavone B. M. (2019). National Partnership for Maternal Safety recommended maternal early warning criteria are associated with maternal morbidity. Anesthesia & Analgesia, 129(6), 1621-1626.[Context Link]


Association of Women's Health, Obstetric and Neonatal Nurses. (2018). Post-birth warning signs education program.


Council on Patient Safety in Women's Health Care. (2020). Urgent maternal warning signs.[Context Link]


Zuckerwise L. C., Lipkind H. S. (2017). Maternal early warning systems-towards reducing preventable maternal mortality and severe maternal morbidity through improved clinical surveillance and responsiveness. Seminars in Perinatology, 41(3), 161-165. [Context Link]