Result of adherence to the modified early obstetric warning system to prevent morbidity and mortality from sepsis
DOI:
https://doi.org/10.12957/reuerj.2025.86705Keywords:
Obstetric Nursing, Pregnancy, Risk Assessment; Sepsis, Clinical ProtocolsAbstract
Objective: to analyze the contribution of adherence to a modified early obstetric warning system for the prevention of morbidity and mortality due to sepsis in pregnant women. Method: quantitative, documentary, retrospective study, using data from the medical records of pregnant women undergoing obstetric screening with sepsis criteria. Data were collected using structured forms, tabulated, and analyzed using descriptive statistics. The Research Ethics Committee approved the research protocol. Results: according to data from 105 pregnant women, signs of sepsis were identified using the Modified Early Obstetric Warning System in 47.3% of cases. Based on the early identification of sepsis, the sepsis bundle was opened by obstetric nurses in 100% of cases. Conclusion: it is evident that adherence to the Modified Early Obstetric Warning System based on evidence of triggers, bundles, and protocols can help in timely diagnosis and treatment to prevent or limit the severity of sepsis morbidity in pregnant women, as well as facilitate patient-centered interdisciplinary care.
References
1. World Health Organization. Improving maternal and newborn health and survival and reducing stillbirth: progress report 2023. Geneva: WHO; 2023 [cited 2024 May 14]. Available from: https://www.who.int/publications/i/item/9789240073678.
2. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016 [cited 2024 May 14]; 315(8):801–10. DOI: https://doi.org/10.1001/jama.2016.0287.
3. Lewis G. Saving mothers’ lives: reviewing maternal deaths to make motherhood safer—2006–2008. BJOG. 2011 [cited 2024 May 14]; 118(Suppl 1):1–203. DOI: https://doi.org/10.1111/j.1471-0528.2010.02847.x.
4. Umar A, Ameh CA, Muriithi F, Mathai M. Early warning systems in obstetrics: a systematic literature review. PLoS One. 2019 [cited 2024 May 14]; 14(5):e0217864. DOI: https://doi.org/10.1371/journal.pone.0217864.
5. Knight M, Bunch K, Patel R, Shakespeare J, Kotnis R, Kenyon S, et al. Saving lives, improving mothers’ care—lessons learned to inform maternity care from the UK and Ireland confidential enquiries into maternal deaths and morbidity 2018–20. Oxford: NPEU; 2022 [cited 2024 May 14]. Available from: https://www.npeu.ox.ac.uk/mbrrace-uk/reports/maternal-reports/maternal-report-2018-2020.
6. Umar A, Ameh CA, Muriithi F, Mathai M. Early warning systems in obstetrics: A systematic literature review. Patman S, editor. PLOS ONE. 2019 [cited 2024 May 14]; 14(5):e0217864. DOI: https://doi.org/10.1371/journal.pone.0217864.
7. Ryan HM, Jones MA, Payne BA, Sharma S, Hutfield AM, Lee T, et al. Validating the performance of the Modified Early Obstetric Warning System Multivariable Model to predict maternal intensive care unit admission. J Obstet Gynaecol Can. 2017 [cited 2024 May 14]; 39(9):728–33. DOI: https://doi.org/10.1016/j.jogc.2017.01.028.
8. Cheshire J, Jones L, Munthali L, Kamphinga C, Liyaya H, Phiri T, et al. The FAST‐M complex intervention for the detection and management of maternal sepsis in low‐resource settings: a multi‐site evaluation. BJOG. 2021 [cited 2024 May 14]; 128(8):1324–33. DOI: https://doi.org/10.1111/1471-0528.16658.
9. Barreiros MP, Carrera HAM, Ferreira ES, Rassy MEC, Portal PSC, Pinto RB, et al. A utilização do escore de alerta obstétrico modificado por enfermeiros no acolhimento com classificação de risco: um relato de experiência. Epitaya E-books. 2022 [cited 2024 May 14]; 1(17):76–88. DOI: https://doi.org/10.47879/ed.ep.2022564p76.
10. Silva APRM, Souza HV. Sepse: importância da identificação precoce pela enfermagem. Rev Pró-UniverSUS. 2018 [cited 2024 May 14]; 9(1):97–100. Available from: https://editora.univassouras.edu.br/index.php/RPU/article/view/1266.
11. Souza ALT, Amário APS, Covay DLA, Veloso LM, Silveira LM, Stabile AM. Nurses’ knowledge on septic shock. Ciênc Cuid Saúde. 2018. DOI: https://doi.org/10.4025/cienccuidsaude.v17i1.39895.
12. Ministério da Saúde (Br). Manual de acolhimento e classificação de risco em obstetrícia. Brasília: Ministério da Saúie; 2018 [cited 2024 May 14]. Available from: https://bvsms.saude.gov.br/bvs/publicacoes/manual_acolhimento_classificacao_risco_obstetricia_2017.pdf.
13. Isaacs RA, Wee MYK, Bick DE, Beake S, Sheehan S, Thomas S. A national survey of obstetric early warning systems in the United Kingdom: five years on. Anaesthesia. 2020 [cited 2024 May 14]; 75(4):489–95. DOI: https://doi.org/10.1111/anae.12708.
1. 12. Lewis G, editor. Saving Mothers’ Lives: Reviewing maternal deaths to make motherhood safer—2006–2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG. 2011 [cited 2024 May 14]; 118(Suppl 1):1–203. DOI: https://doi.org/10.1111/j.1471-0528.2010.02847.x.
2. 13 Isaacs RA, Wee MYK, Bick DE, Beake S, Sheehan S, Thomas S. A national survey of obstetric early warning systems in the United Kingdom: five years on. Anaesthesia. 2020 [cited 2024 May 14]; 75(4):489–95. DOI: https://doi.org/10.1111/anae.12708.
14. Magee LA, Brown MA, Hall DR, Gupte S, Hennessy A, Karumanchi SA, et al, von Dadelszen P. The 2021 International Society for the Study of Hypertension in Pregnancy classification, diagnosis & management recommendations for international practice. Pregnancy Hypertens. 2022 [cited 2024 May 14]; 27:148-69. DOI: https://pubmed.ncbi.nlm.nih.gov/35066406/.
15. Douglas KA, Redman CW. Eclampsia in the United Kingdom. BMJ. 1994 [cited 2024 May 14]; 309(6966):1395–400. DOI: https://doi.org/10.1136/bmj.309.6966.1395.
16. Pirkle CM, Dumont A, Zunzunegui MV. Medical recordkeeping, essential but overlooked aspect of quality of care in resource-limited settings. Int J Qual Health Care. 2012 [cited 2024 May 14]; 24(6):564-7. DOI: https://doi.org/10.1093/intqhc/mzs034 .
17. Bernardino FBS, Gonçalves TM, Pereira TID, Xavier JS, Freitas BHBM, Gaíva MAM. Trends in neonatal mortality in Brazil from 2007 to 2017. Ciênc. saúde coletiva. 2022 [cited 2025 jul 02]; 27(2):567-78. DOI: https://doi.org/10.1590/1413-81232022272.41192020.
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Marianny Medeiros de Moraes, Amuzza Aylla Pereira dos Santos, Juliana Duque da Silva de Sá Leitão, Kassiara Ferreira Felix de Lima Farias, Nathalya Anastacio dos Santos Silva, Laryssa Silva Oliveira, Luana Carla Gonçalves Brandão Santos Almeida, Lavínia Helena Rufino da Silva

This work is licensed under a Creative Commons Attribution 4.0 International License.
When publishing in Revista Enfermagem UERJ, the authors declare that the work is their exclusive authorship and therefore assume full responsibility for its content.
Authors retain copyright to their article and agree to license their work using a Creative Commons Attribution International Public License (CC BY), thereby accepting the terms and conditions of this license (https://creativecommons.org/licenses/by/4.0/legalcode.en), which allows material created by the author to be distributed, copied and displayed by third parties. The original work must be cited and present a link to the article available on the website of the journal in which it was published.
The Copyright of the articles published in Revista Enfermagem UERJ belongs to their respective author(s), with the rights of first publication assigned to Revista Enfermagem UERJ, with the work simultaneously licensed under a Creative Commons License CC BY, which allows sharing of work with recognition of authorship and initial publication in this journal.
The authors grant Revista Enfermagem UERJ the right of first publication, to identify themselves as the original publisher of the work and grant the magazine a license of non-exclusive rights to use the work in the following ways:
- Sell and/or distribute the work in printed copies and/or electronic format;
- Distribute parts and/or the work as a whole with the aim of promoting the magazine through the internet and other digital and printed media;
- Record and playback work in any format, including digital media.
In line with the journal's policies, each published article will be assigned a Creative Commons Attribution (CC BY) license.



