Obstetric early warning score in Scandinavia. A survey of midwives' use of systematic monitoring in parturients.

OBJECTIVE: systematic monitoring has recently been implemented widely in non-obstetric departments. In the UK, Early Warning Score (EWS) systems specifically designed for the obstetric population (OEWS) are used. No information on the use of OEWS in Scandinavia has been reported. Consequently, we wanted to investigate the use of vital signs and attitude towards systematic monitoring of parturients in Denmark, Norway and Sweden. DESIGN: electronic questionnaires sent to heads of midwifery. The heads of midwifery referred two clinically active midwives. All in-hospital obstetric departments in Scandinavia were invited to participate. FINDINGS: heads of midwifery from 76 departments (68%), and 125 clinical midwives (82%) responded. Ten per cent of midwives reported use of OEWS. Reported implementation barriers to OEWS included lack of evidence and suspected impact on the parturient due to frequent interruptions. fifty-four per cent of clinical midwives reported a systolic blood pressure threshold of 90-139mmHg, while 33% reported a threshold of>160mmHg. Ninety-three per cent stated a low threshold for maternal heart rate<60 bpm whereas 10% reported an upper threshold heart rate ≥ 150 bpm. Forty-seven per cent reported call for assistance thresholds for maternal heart rate at 60-110 bpm. KEY CONCLUSIONS: OEWS is not implemented in Scandinavian obstetric departments and reported thresholds of vital signs varied considerably. Major barriers for implementation in Scandinavia include midwives' concern of interruptions for the parturient and increased workload, and unclear benefit from use of OEWS. Local departments should provide midwives with unambiguous thresholds for vital signs in parturients either through local guidelines or via OEWS.

Aerococcus christensenii as Part of Severe Polymicrobial Chorioamnionitis in a Pregnant Woman.

Chorioamnionitis is a potentially life threatening infection of the fetal membranes, commonly caused by ascending bacteria from the vagina and cervix. In our case, a healthy nullipara with a term pregnancy presented clinical signs of infection after induced labour with an intracervical balloon. Thick green and foul smelling amniotic fluid was observed and culture showed massive growth of Aerococcus christensenii, a facultative anaerob species found in the human vagina, previously only rarely alleged to cause invasive infection. Additional testing with 16S rRNA gene analysis also identified the presence of Gemella asaccharolytica, Snethia sanguinegens, P arvimonas micra and S treptobacillus moniliformis. The patient was treated with cefuroxime and metronidazole and recovered quickly. The newborn showed no signs of infection. This case points at the possible role of these pathogens in female genital tract infections. The case also underlines the importance of the combination of culture and culture independent diagnostic approaches to reveal possible polymicrobial natures of selected infections, in this case chorioamnionitis.