MOEWS Calculated
Score = 0 - 2
- Antenatal = Daily
Observations
- Postnatal = at least 12
hourly observations
Score = 3 - 5
Within 30 Minutes you
must
- Inform Senior Midwife
- Inform Senior
Obstetrician, ST3 or above
Score 6 or Above
Within 15 Minutes you must
- Inform Shift leader
- Inform Senior Obstetrician, ST3 or above.
- Inform the Anaesthetist
- Transfer to delivery suite
Senior Obstetrician, ST3 or above
review within time frame
Yes
Senior Obstetrician, ST3 or above to ensure
- The consultant Obstetrician is informed
- Review and document management plan in the health record
- Multidisciplinary team is involved as appropriate
- Consider transfer to Delivery Suite
No
- Call Consultant Obstetricia
- Contact the Anaesthetic Registrar/Consultant as required
- Depending on the MOEWS consider critical care referral
as per Trust guidelines
Does the woman have any Two of the following?
- Temperature under 36oC or Over 38.3oC
- Heart Rate - over 100 bpm Antenatal
- over 90 bpm Postnatal
- Respiratory Rate over 24/minute
- White Cells less than 4, more than 12 x 10 /L
- Blood Sugar more than 7.7 in the absence of diabetes
- Acutely altered mental state
No
- Follow standard MOEWS protocol
- Re-apply screening tool if situation changes
- Consider source of infection
without inflammatory response
- Consider source of infection without
inflammatory response
Is the History Suggestive of New infection?
- Prolonged Spontaneous Rupture of the membranes.
- Unexplained foetal tachycardia in the absence of a maternal tachycardia.
- Urinary Tract Infection
- Catheter or other line infection.
- Meningitis
- Pneumonia
- Peritonitis
- Offensive liquor.
- Breast redness/tenderness/ mastitis
- Intra Uterine Death/ Stillbirth
- Cellulites / Septic Arthritis/ Fasciitis / Wound Infection
- Endocarditis
- Diarrhoea
No
Look for non-infective causes
- Pancreatitis
- Transfusion
reaction
- Trauma
- Burns
- Thromboembolism
Management of Sepsis Patient
Patient has Sepsis
- Seek Senior Review
- Consider seeking critical care opinion
- Oxygen : High Flow 15L / min via a non-re breather mask
- Blood Cultures: Take at least one set prior to antibiotics Plus FBC, U&E, LFT, Clotting, Glucose, Lactate,
- Serum Lactate If more than 2 with signs of organ dysfunction inform Senior Anaesthetist.
- Inform ITU
- IV Antibiotics - 1st dose to be given within the first hour
- Fluid Resuscitation
- Continue MOEWS every 30 mins
- Monitor fluids and record fluid balance hourly
- Catheterise and commence HDU Chart (if not commenced)
- VTE Prophylaxis
- Consider Delivery or ERPC
Does the woman have any signs of Organ dysfunction?
- Blood Pressure systolic less than 90 or MAP of less than 65
- New need for O2 to keep SpO2above 90%
- Urine Output less than 0.5 ml /KG for 2 hours
- Bilirubin more than 34 μmols/l
- Platelets less than 100 x 10 L
- INR less than 1.5 or aPTT less than 60s
- Lactate more than 2mmol /L
- Creatinine more than 170 mmol/L
Yes - Patient has Severe Sepsis
No
- Reassess patient
- Document appropriate management plan
Systolic BP <90mmHg or MAP <65mmHg or a fall of >40mmHg or
lactrate >4mmol from baseline after resuscitation?
Yes
Septic Shock
Refer to Critical care?
Accepted for ITU/HDU
Transfer ITU/HDU
- Ensure patient has received adequate fluid resuscitation: boluses of 30ml/kg
0.9% saline or Plasma-lyte
- If still shocked (low BP/ low urine output/ high lactate) insert central venous
catheter under USS guidance (only if competent; otherwise seek help)
- Aim to achieve CVP 8-12mmHg with Care, Check CVP Monitor
- Consider noradrenaline if still shocked or dobutamine if ScvO2 < 70%.
Consider +/-blood transfusion
- Take heparinised sample from central line (use ABG syringe): check
ScvO2>70%
- Consider blood transfusion if haematocrit < 30 and ScvO2 <70%.
- Recheck Lactate if initially high >4 mmol/L
- Review Antibiotics
- Daily Obstetric review if antepartum
No
Severe sepsis, no shock
- Refer to Critical Care /CCOT/Acute
Response Team
- Ensure management plan is documented
in notes
- Ensure hourly MOEWS taken, recorded
and acted upon.
- Monitor urine output
- Record hourly fluid balance
- Monitor blood test for signs of AKI
- daily antibiotic review
- Medical review at 6 hrs
If patient fails to respond to treatment refer to critical care