Maternal Deaths during a Pilot Study Using Digitized Maternal Early Warning System

Abstract

Global maternal mortality remains high, and further reduction requires innovative approaches. We developed and tested a telehealth solution that included an early warning system (EWS) and a clinical decision support (CDS) tool for the timely detection of clinical deterioration and appropriate management of women in labor. Those results were published earlier. As a follow-up to that study, we examine and analyze why preventable deaths occurred despite the telehealth EWS that alerted the providers along with treatment guidelines. Twelve maternal deaths occurred during that study, of which six occurred at the study sites and six others after transport to a tertiary institution. Nine of those were determined preventable. Telehealth identified at-risk patients in every case, provided red alerts in acute emergency (66.7%) and/or yellow alerts requiring continued observation (33.3%). Three factors that may have a positive impact on the use of a telehealth are coordinated transfers, proper referral networks, and institutional protocols and addressing the knowledge gaps of providers. EWS and CDS tools have a potential to positively impact maternal deaths by identifying developing crises of patients in a timely manner and alerting the providers. In resource-limited settings, EWS with telehealth capabilities can be particularly valuable.