Validation of Early Warning Systems for Severe Maternal Morbidity and Individualised Prediction of Severe Maternal Morbidity within Ethnic Groups

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What is the aim of the research?This research is about understanding the best system to identify women from all ethnic groups who are unwell during or after pregnancy. This will ensure health inequalities do not affect the recognition of medical problems and will enable faster treatment to prevent severe illness and death.What is the research about?The 'early warning score' is a system used in everyday medical care to identify women at risk of severe illness. Severe illness includes pregnancy-related problems like infection, high blood pressure, and bleeding, as well as medical problems unrelated to pregnancy. The 'vital signs' of the pulse, blood pressure, rate of breathing, temperature and oxygen level are measured several times per day for women in hospital. Healthcare workers calculate an 'early warning score' based on these vital signs. The higher the number, the greater the risk of severe illness in the short term, and the more urgent the woman's care becomes. The purpose is to ensure fast diagnosis and treatment of illness.The problem is that the evidence for these 'early warning scores' is poor. Scores are developed, changed, and used without testing how good they are. Consequently, hospitals use over a hundred different scores in obstetrics and this means that how the risk of severe illness is calculated varies unacceptably. Additionally, in the UK the risk of a woman becoming severely unwell and dying is different based on her ethnicity. No early warning scores have been tested to make sure they perform well in different ethnic groups. If we do not measure and understand differences then we risk creating early warning scores that work for most women but not all women.Second, there is a large amount of important and easily-accessible information that is not included in early warning scores. For example, a woman's age, body mass index, and medical problems would help to interpret her vital signs and understand her risk of illness better. This information should be used if it can help to account for differences between ethnic groups and prevent severe illness.How will the research be undertaken?Initially, I need to understand why women from some ethnic groups are at higher risk of severe illness. I will therefore review the existing scientific literature in depth to identify the most important risk factors in different ethnic groups. I also need to understand how early warning scores are used in real life, so I will review the medical records and interviews of women who had abnormal vital signs, and interview healthcare workers. I want to make sure early warning scores help treat illness in all women fairly. I will test whether existing scores work well in each ethnic group using information from the electronic medical records of a large group of women. I will then take some of the most sophisticated early warning systems and test whether adding extra risk factors that are important within individual ethnic minority groups makes them perform more fairly.Who will be involved in the research?Women from different ethnic backgrounds who have experienced severe illness during or after pregnancy have been consulted on the design of the research. They will be involved in conducting the research, and refining the research plan at key points. Involvement will be facilitated through a workshop event. The public and healthcare decision-makers will be involved and updated throughout the research. Findings and recommendations will be shared among the public and community, professional committees from different healthcare groups, and patient advocacy groups.