Search

Malaria is a common infection world-wide, which carries significant risk of morbidity and mortality. Health care providers in the United States may lack experience in recognizing and treating this disease. The pathophysiology of malaria differs during pregnancy, resulting in increased risk for serious morbidity and mortality for the woman and her fetus. Screening for risk factors, especially immigration from and travel to endemic countries, is critical. Symptoms of malaria can mimic influenza-type illnesses, causing delay in diagnosis. Consultation with an infectious disease specialist and hospitalization may be required for appropriate testing and treatment. Chemoprophylaxis and counseling regarding methods to reduce risk are important components of prevention. The US Centers for Disease Control and Prevention and the World Health Organization have established protocols for treatment and are helpful resources for clinicians. A team approach to care based on the woman's stage of illness and recovery, can involve midwives, physicians, specialists and others., (© 2021 by the American College of Nurse-Midwives.)

Case reviews of maternal death have revealed a concerning pattern of delay in recognition of hemorrhage, hypertensive crisis, sepsis, venous thromboembolism, and heart failure. Early-warning systems have been proposed to facilitate timely recognition, diagnosis, and treatment for women developing critical illness. A multidisciplinary working group convened by the National Partnership for Maternal Safety used a consensus-based approach to define The Maternal Early Warning Criteria, a list of abnormal parameters that indicate the need for urgent bedside evaluation by a clinician with the capacity to escalate care as necessary in order to pursue diagnostic and therapeutic interventions. This commentary reviews the evidence supporting the use of early-warning systems, describes The Maternal Early Warning Criteria, and provides considerations for local implementation., (© 2014 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.)