Interventions to facilitate clinical escalation of care around birth: a
rapid overview of current evidence
Background: Effective clinical escalation on recognition of maternal or
fetal deterioration is a crucial component of maintaining safety in
intrapartum settings. Objective: To overview systematic reviews on
interventions for escalating care around birth. Search strategy: Reviews
published 2015 to 2021. Sources searched included eight databases.
Selection criteria Reviews involving randomised controlled trials on the
clinical impact on mothers and neonates, process outcomes, and/or
qualitative evidence on stakeholders’ perspectives on intervention.
Where gaps were found other types of review evidence were considered.
Data collection and analysis Cochrane approaches applied including in
evaluating evidence quality. Results Seven systematic reviews and one
scoping review were relevant for in-depth review: six were on clinical
impact, and two on perspectives (studies from 16 countries, over 909,027
pregnancies/births of undefined risk). In comparison with no
intervention, early warning systems trigger tools and team training in
obstetric emergencies were evaluated. Various measures of clinical
impact were used, only one on time-to-treat. We found that most evidence
was of low to very-low quality because of study limitations and
imprecision as outcomes are rare, and overall failed to find a clinical
improvement favouring early warning systems trigger tools or training.
Qualitative studies captured challenges in implementing trigger tools.
Reviews of women’s perspectives or other types of care escalation were
searched but not identified. This is not to suggest studies don’t exist.
Conclusions Conclusions cannot be made on clinical effect of
interventions to escalate care around birth as review evidence is
limited. Evaluations need to consider use of proxy outcomes.