Appendix 2. Differential Diagnoses
Blood pressure >160 systolic or >100 diastolic Common diagnoses:
Chronic hypertension Preeclampsia
Sympathomimetic medications (methylergonovine, phenylephrine, other vasopressors) Rare but life-threatening diagnoses:
Illicit substances (e.g., cocaine, amphetamines)
Endocrine disorders (pheochromocytoma, hyperthyroidism, renal artery stenosis)
Hypoventilation with hypercarbia (e.g., opiate-related, obstructive sleep apnea, respiratory muscle weakness)
Blood pressure <90 systolic Common diagnoses:
Dehydration
Supine hypotension syndrome Regional anesthesia side-effect
• Hypotension solely due to regional anesthesia is unusual if the cephalad anesthetic level is at T10 or below.
Hemorrhage
Medication side-effects (beta-blockers, Calcium channel blockers) Vasovagal reaction (in presence of bradycardia)
Rare but life-threatening diagnoses:
Sepsis
Cardiac (cardiomyopathy, right or left heart failure, myocardial ischemia, pericarditis, cardiac tamponade, arrhythmia)
Thromboembolism (PE)
Concealed hemorrhage (retroperitoneal hemorrhage, abruption, uterine rupture) Amniotic fluid embolism
Anaphylaxis
Diabetic ketoacidosis
Drug toxicity (magnesium, local anesthetic) High spinal or epidural block
Tension pneumothorax
Vascular emergency (splanchic arterial dissection, aortic dissection)
Myhre JM, D’Oria R,Hameed AB, Lappen JR, Holley SL, Hunter SK, et al. The Maternal Early Warning Criteria: a proposal from the National Partnership for Maternal Safety. Obstet Gynecol 2014;124.
The authors provided this information as a supplement to their article.
© Copyright 2014 American College of Obstetricians and Gynecologists. Page 2 of 5
Heart rate >120 bpm Common diagnoses:
Dehydration Hemorrhage Infection
Medication side effects (sympathomimetics, beta-2 agonists) Anxiety/pain/panic attack
Rare but life-threatening diagnoses:
Cardiac (cardiomyopathy, right or left heart failure, myocardial ischemia, pericarditis, pericardial tamponade, tachyarrhythmia)
Illicit drugs (e.g., cocaine, amphetamines) Thromboembolism (PE)
Concealed hemorrhage (retroperitoneal hemorrhage, abruption, uterine rupture) Amniotic fluid embolism
Anaphylaxis
Endocrine disorders (pheochromocytoma, hyperthyroidism/thyroid storm) Malignant hyperthermia
Vascular emergency (splanchic arterial dissection, aortic dissection)
Heart rate <50 Common diagnoses:
Vasovagal reaction (in presence of hypotension) Medication side-effects (beta-blockers)
Hypertension (reflex bradycardia) Rare but life-threatening diagnoses:
Heart block from cardiac disease (e.g., myocardial infarction, myocarditis, or hemochromatosis) Hypoventilation or hypoxemia (e.g., obstructive sleep apnea)
Electrolyte disturbances (K, Na, Ca, Mg) Medication toxicity (magnesium) Stroke/increased intracranial pressure High spinal or epidural block
Respiratory rate >30 Common diagnoses:
Hypoxia (e.g., asthma) Hemorrhage
Infection (e.g., sepsis, pneumonia) Anxiety/panic attack/exertion Rare but life-threatening diagnoses:
Cardiac (Cardiomyopathy, right or left heart failure, myocardial ischemia) Thromboembolism (PE)
Aspiration
Metabolic acidosis including Diabetic Ketoacidosis
Concealed hemorrhage (retroperitoneal hemorrhage, abruption, uterine rupture) Amiotic fluid embolism
Stroke
Respiratory rate <10 Common diagnoses:
Medication toxicity (opioids, benzodiazepines, magnesium) Obstructive sleep apnea
Rare but life-threatening diagnoses:
Airway obstruction
Asthma with respiratory failure High spinal or epidural block Cerebrovascular accident
Myhre JM, D’Oria R,Hameed AB, Lappen JR, Holley SL, Hunter SK, et al. The Maternal Early Warning Criteria: a proposal from the National Partnership for Maternal Safety. Obstet Gynecol 2014;124.
The authors provided this information as a supplement to their article.
© Copyright 2014 American College of Obstetricians and Gynecologists. Page 4 of 5
Oxygen saturation <95% or increasing oxygen requirements to maintain oxygen saturation ≥95%
Common diagnoses:
Atelectasis (following anesthesia, Obesity, supine position at the end of pregnancy) Bronchospasm (asthma)
Hemorrhage
Hypoventilation (obstructive sleep apnea, opiate or benzodiazepine effect) Infection (e.g., pneumonia)
Rare but life-threatening diagnoses:
Airway obstruction (asphyxia, laryngospasm) Pulmonary edema
Thromboembolic disease (PE)
Cardiac disease (cardiomyopathy, right or left heart failure, intracardiac shunt) Concealed hemorrhage (retroperitoneal hemorrhage, abruption, uterine rupture) Amniotic fluid embolism
Anaphylaxis Aspiration
Acute chest syndrome (sickle cell disease) Pneumothorax
Venous air embolism
Blood product reaction (TACO, TRALI, anaphylaxis)
Maternal confusion, agitation or unresponsiveness Common diagnoses:
Hypoxemia
Hemorrhage / hypotension
Illicit substances (either intoxication or withdrawal)
Seizure/post-ictal state/PRES (posterior reversible encephalopathy syndrome) Psychosis is a diagnosis of exclusion
Rare but life-threatening diagnoses:
Diabetic ketoacidosis, hypoglycemia Sepsis
Concealed hemorrhage (retroperitoneal hemorrhage, abruption, uterine rupture) Thromboembolic disease (PE)
Amniotic fluid embolism Anesthesia complications Cardiomyopathy
Cerebrovascular accident, cavernous sinus thrombosis Increased intracranial pressure
Electrolyte abnormality (hypermagensemia) Hyperthyroidism / thyroid storm, myxedema coma Medication toxicity
Oliguria <35 mL/hr over a 2hr period Common diagnoses:
Severe dehydration Hemorrhage
Obstructed urinary catheter Rare but life-threatening diagnoses:
Surgical complications Genitourinary tract injury
Preeclampsia with Severe Features Sepsis
Concealed hemorrhage (retroperitoneal hemorrhage, abruption, uterine rupture) Acute renal failure