Defining, Recognising and Escalating Maternal Early Deterioration (DREaMED): Decreasing inequality through improved outcomes

Every year more than 700,000 women give birth in the United Kingdom. Of these at least 8700 nearly die – called a “near-miss”, and 70 die. Many more women suffer harm, often with effects lasting for life. Women from less wealthy areas and particular ethnic groups are more likely to come to harm."Vital signs" include measurements of blood pressure, heart and breathing rates. Doctors and midwives use tools that score vital signs to spot women becoming unwell. These tools are called “Modified Obstetric Early Warning Scores” (MOEWS). Despite their use, poor outcomes still occur. This may be because MOEWS use only the most recent vital signs. Using extra data like blood tests helps spot unwell people earlier.We aim to reduce poor outcomes for women giving birth. We will find better ways of describing, spotting, and treating women becoming unwell.We plan four linked projects to develop an electronic advanced maternal obstetric early warning system (eMOEWS). Patient and Public (PPIE) collaborators have developed this work with us. We will work closely with them throughout this project.Once we have completed these four projects, we plan to carry out a trial to assess whether the new eMOEWS leads to better outcomes than the existing tools. This trial will be described in a separate protocol.Project OneWe will develop new definitions of worsening illness in women giving birth. We will work with our PPIE colleagues and other experts, reviewing published work. This will help staff use routinely collected health data to spot early illness, before a woman becomes very unwell. We will check that the new definitions reliably identify women becoming unwell.Project TwoUsing the new definitions, we will test how well current MOEWS pick up worsening illness. We will use data from eight to twelve NHS maternity units serving diverse women, and our national maternal review programme.Project ThreeWe will develop an advanced, electronic MOEWS (eMOEWS) working with our PPIE collaborators and other experts. This will use extra information known to affect the risk of poor outcomes. We will test how well the eMOEWS spots worsening illness, using our new definitions.Project FourWe will develop a way to display eMOEWS on maternity units. We will work with staff who use computers along with experts in NHS computer systems. This will allow staff to understand quickly which women are at risk, and why. We will design guidelines for how to use eMOEWS on maternity units with women and staff. This will make sure our new system helps give women the right care at the right time.