title: Implementation of warning tool to improve maternal newborn health outcomes in a developing country.
abstract: OBJECTIVE
  To improve health outcomes through the implementation of national early warning sign tool for babies delivered through emergency caesarean section in off-work hours.
  
  
  METHODS
  This comparative clinical study was conducted at the Aga Khan Hospital for Women and Children, Karachi, from April to August 2014, and comprised women who had an emergency caesarean section. Maternal and perinatal outcomes were compared of patients in Group A and Group B which represented individuals before and after the implementation of the national early warning score respectively.
  
  
  RESULTS
  Of the 200 participants, there were 100(50%) in each group. The overall mean age was 26.79±5.10 years. The mean age was 26.3±5 years in Group A, and 27.2±5 years in Group B (p=0.25). The two groups were also comparable in terms of parity (p=0.77) and co-morbidities (p =0.51). There was no stillbirth or maternal death, but decline in complications due to post-partum haemorrhage (p=0.00) was observed due to early recognition and timely management. None of the women required referral to higher facility.
  
  
  CONCLUSIONS
  National early warning score was found to be a practical early warning tool for obstetric population.
authors.affiliation: Division of Women and Child Health, Department of Obstetrics and Gynaecology, Aga Khan University, Karachi, Pakistan.
authors.forename: Sana
authors.initials: S
authors.lastname: Sheikh
authors.affiliation: Division of Women and Child Health, Department of Obstetrics and Gynaecology, Aga Khan University, Karachi, Pakistan.
authors.forename: Rahat
authors.initials: R
authors.lastname: Qureshi
authors.affiliation: Division of Women and Child Health, Department of Obstetrics and Gynaecology, Aga Khan University, Karachi, Pakistan.
authors.forename: Sidrah
authors.initials: S
authors.lastname: Nausheen
authors.affiliation: Division of Women and Child Health, Department of Obstetrics and Gynaecology, Aga Khan University, Karachi, Pakistan.
authors.forename: Rozina
authors.initials: R
authors.lastname: Sikandar
mesh_terms: D000328:Adult; D002585:Cesarean Section; D004630:Emergencies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D000068097:Maternal Health; D018743:Perinatal Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011256:Pregnancy Outcome / Q000453:epidemiology*; D055815:Young Adult
keywords: Early warning tool, Maternal outcome, Emergency caesarean section. 