Grant: Catalyst Grant : Maternal Health: From Pre-Conception to the Empty Nest

In 1900, women had a 1 in 12 lifetime risk of dying from pregnancy complications. The freedom to choose when to become pregnant, and the expectation when pregnant both to remain healthy and to have a healthy child, combine to be one of the great successes of women's health care in the past century. Pregnancy is a physiological event and usually passes without significant risk for either mother or fetus. Yet still today, in Canada and worldwide, there are pregnant women who will become critically ill, some of whom will die. However at present, there are no measurement tools to offer those women who do become critically unwell during pregnancy. Therefore, our plan is two-fold: 1) To validate a clinical prediction model - the Modified Early Obstetric Warning System (MEOWS) - that aims for early identification of pregnant/postpartum women at risk for becoming critically unwell. 2) To develop and validate a new clinical prediction model - the Canadian Integrated Pregnancy High-dependency Estimate of Risk (CIPHER) - that identifies which pregnant/postpartum women admitted to the intensive care unit (ICU) are truly at risk of three-organ failure or death. If MEOWS and CIPHER are validated, then they have the potential to significantly impact women's health care worldwide and help countries achieve their Millennium Development Goals. MEOWS can be used to screen pregnant or recently pregnant women to determine who are high-risk to become critically ill: these women can then be admitted to the ICU for closer monitoring. For those pregnant or postpartum women admitted to the ICU, the CIPHER model can then be used to predict who are at highest-risk for three-organ failure or death: these women can then receive more intensive management.