Design and evaluation of maternal early warning system to reduce preventable maternal mortality in pregnancy and puerperium for high-risk women in China.

Background: The maternal early warning system is an effective tool to reduce maternal mortality and morbidity. However, there has been limited research on developing a maternal early warning system especially suitable for Chinese high-risk pregnant women.

Objective: The purpose is to develop a maternal early warning system to reduce preventable maternal mortality in pregnancy and puerperium in high-risk women in China.

Design: A cross-sectional survey design.

Setting: The study was conducted in a first-level hospital in China.

Participants: A total of 306 pregnant women were selected as the objects who were admitted to give birth from April to June 2021 in xxx.

Methods: A convenience sampling method was used to select 42 experts from 20 hospitals in more than 10 cities in east and west China, which represents the developed and undeveloped cities. The maternal early warning indicators of high-risk pregnancy during pregnancy and after birth were determined via literature research, research group discussion, and the Delphi expert consultation.

Measurements And Findings: The final maternal early warning system for high-risk women in pregnancy and puerperium included 8 first-level indicators and 30 second-level indicators. The expert authority coefficients of the two rounds of consultation were 0.92 and 0.94, respectively. The Kendall harmony coefficients were 0.252 and 0.386, respectively (P<0.001). The area under the ROC curve predicted by the early warning system for high-risk pregnancy during childbirth was higher than 0.86, and the best cut-off point was 9.97. It was statistically significant (P<0.001).

Key Conclusions: The constructed maternal early warning system for high-risk pregnancy in pregnancy and puerperium has comprehensive contents and high reliability, which will help midwives to identify high-risk pregnancies during childbirth.

Implications For Practice: The results of this study can help to detect deterioration of the patient, predict morbidity in high-risk women and enable timely intervene to prevent possible severe illness.