One story at a time, one life at a time, one calling: Make a difference.
The call goes out for a "26 year-old female with possible seizure". Upon arrival you find a young African-American female, Sheila, who is lying on the sofa at her residence. You hear the crying of a baby in the basinet nearby. Her husband, Gary, who happens to be a lab tech at a hospital nearby, reports that she had been complaining of a headache all day. Gary states, "We just had a baby last week. I am not sure what's happening. We haven't been getting much sleep. She just started shaking uncontrollably all over and then stopped after a couple minutes. She's won't talk to me." You start your assessment, but you wonder, what is really going on here?
Partum and peri-partum calls don’t happen all that often, but as an EMS professional you can expect to respond to the type of case described above at least few times in your career.
In 1986 the CDC began tracking pregnancy-related deaths and since collecting this data rates have more than doubled. Although we may not realize it, the United States has the highest maternal mortality rate of any highly developed nation, according to the Alliance for Innovation on Maternal Health (AIM). Few nations beside the USA have a rising maternal mortality rate, amongst them are Afghanistan and Sudan.
My wife, an OB/GYN physician, shared with me her experiences from a recent conference in Austin whose sole purpose was to develop a statewide strategy on reducing maternal mortality in the state of Texas. One heart wrenching experience she shared was that of Kira Johnson, who entered a hospital for an elective cesarean section and never made it out alive. Watching a montage video in memory of Kira floored us. Childbirth is a time for celebration by all standards, so any deviation from the expected joy is both tragic and unacceptable. Take a moment to watch the video, because a learning a statistic feels too numerical, but learn the story of one person’s loss of life and a compelling reason for change is illuminated.
The leading drivers of mortality surrounding child birth are peripartum hemorrhage, cardiovascular events, infection, severe hypertension/ preeclampsia and embolism. A review of cases suggests that over half of pregnancy-related deaths are preventable. And maternal mortality is unfortunately outnumbered by cases of maternal morbidity by a hundred to one.
Leading Underlying Causes of Pregnancy-Related Deaths
Efforts at reducing maternal morbidity and mortality directed mainly at hospital-based providers (such as OB/GYNs, L&D nurses, OB anesthetists) underway have distilled an evidence-based warning system. The Maternal Early Warning Signs (MEWS) protocol developed by AIM has demonstrated success in improving outcomes. MEWS is a vital signs and patient assessment driven screening protocol that can easily translate to the pre-hospital setting and assist in evaluation of the gravid or recent post-partum patient.
Understanding the unique needs and presentations of this special population is imperative to better care. Being aware of red flags on the frontlines and understanding their clinical implications may very well make all the difference in a new mother's life.
Maternal Early Warning Signs (MEWS)
In a future article, we will further explore MEWS and the peripartum patient in the pre-hospital setting.
We at MedCognition™are developing a mixed-reality female patient simulator as part of the PerSim™system for pre-hospital professional training and would greatly appreciate any thoughts the EMS community can provide. Feel free to leave comments below.
Hector Caraballo, MD is a practicing Board Certified Emergency Physician and Chief Medical Officer at MedCognition.