The seventh report on conidential enquiries into maternal deaths in the UK made a recommendation that all hospi-tals, including all departments that provide care for preg-nant women, e.g. Emergency Department, Gynaecology, should use an Early Warning Scoring (EWS) system until a national obstetric EWS chart is available (Lewis 2007). It
Figure 6.1 A, Adult pulse oximetry probe. B, neonatal pulse oximetry probe.
(Adapted with kind permission from Jamieson et al 2002) A
B
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6| Chapter
Assessment of maternal and neonatal vital signs: respiration assessment
SUMMARY
•
Assessing respiration in an adult should be undertaken discreetly.•
A baby’s respiratory rate can be observed or felt and should be counted for 60 seconds.•
Respiration assessment includes rate, depth, regularity, sound and posture.•
The general condition of the woman or baby is assessed simultaneously.•
Pulse oximetry is an accurate, non-invasive technique that measures oxygen saturation via a correctly itted peripheral probe and can be used as a screening tool for critical congenital heart disease in the newborn.•
A MEOWS chart should be used for pregnant and postnatal women who have or are at risk of developing deviations from the normal.the respiratory rate is the most important of the variables recorded for assessing the clinical condition, yet it is also the one that is recorded the least. Each of the results are given a score between 0–3 and the scores should be totalled each time the MEOWS is used. The chart contains informa-tion on what pathway to take with each totalled score and it is important the midwife takes the appropriate action. In particular, it should identify who to call and how (so timely response occurs), and how and when the clinical chain of command should be contacted (Mhyre et al 2014). The MEOWS chart can be used for pregnant women from 20 weeks’ gestation and can be modiied to include postnatal factors up to 6 weeks (Cole 2014).
McGlennan & Sherratt (2013) discuss the National Early Warning Score (NEWS), which was implemented in 2012, and the recommendation by the NEWS Development and Implementation Group that NEWS should not be used within obstetrics because it does not take into account the physiological changes associated with childbirth. The MEOWS chart does take these changes into account and thus should be more sensitive in detecting changes to the pregnant woman’s condition. However, Clutton-Brock (2007) advises MEOWS can only be part of the solution, as it is the response to the abnormal score that determines whether there will be any real change to the outcome. Mhyre et al (2014) suggest that this form of monitoring is the cornerstone of timely diagnosis and treatments and that it should detect abnormality and trigger a response. Singh et al (2011) found that women who had triggered were more likely to develop or already have morbidity and conclude that MEOWS is a simple bedside screening tool for maternal morbidity. McGlennan & Sherratt (2013) suggest the use of MEOWS has improved the recording of 4-hourly postopera-tive observations and recognize it may assist in the early detection of pre-eclampsia or sepsis and facilitate earlier detection of maternal illness. There is not yet a national MEOWS chart but a deinite need for one (Carle et al 2013).
ROLE AND RESPONSIBILITIES OF THE MIDWIFE These can be summarized as:
• recognizing the signiicance of respiration assessment, when it is indicated and when other interventions such as pulse oximetry are required
• recognizing normal respiration rates, depths, patterns, and sounds and identifying deviations from normal for both the woman and the baby
• undertaking the assessment correctly
• using pulse oximetry appropriately
• completing the MEOWS chart accurately and identifying and acting on any triggers found.
SELF-ASSESSMENT EXERCISES
The answers to the following questions may be found in the text:
1. Discuss how pregnancy, labour, and the puerperium affect respiration. What would be the accepted normal values during these times?
2. Identify ive factors that may increase respiration.
3. Why is a preterm baby more likely to develop respiratory problems than a term baby?
4. Describe when the midwife is likely to complete a respiration assessment:
a. for a woman b. for a baby.
5. Which factors affect the accuracy of pulse oximetry?
6. Summarize the role and responsibilities of the midwife when undertaking respiration assessment.
7. What is a MEOWS chart and why should it be used for a woman following a caesarean section?
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Assessment of maternal and neonatal vital signs:
neurological assessment
Chapter
function and vital signs. A reduced assessment of level of consciousness, motor signs (limb movement), pupillary assessment in conjunction with vital signs – respiration, heart rate, blood pressure, temperature and oxygen satura-tion – can be undertaken by the midwife. The midwife must be appropriately trained to enable her to complete a neu-rological assessment competently and safely, as it provides invaluable information regarding the woman’s condition.
The Modiied Early Obstetric Warning Scoring (MEOWS) chart may contain some of the components of neurological assessment, e.g. alertness, response to stimulation (p. 66) This chapter focuses on the principles of neurological assessment and the midwife’s role in relation to undertak-ing this assessment.