Obstetric early warning scores in pregnancy and postpartum, and when to escalate
- Assessment
The obstetric warning score adds points for abnormal vital signs; the total tells the nurse how often to observe and whom to call.
What it is
Res. 3280 de 2018 adopts the Maternal Early Obstetric Warning Score adapted for Colombia (Annex 5). It is used to watch women in pregnancy and after birth. Each vital sign scores from 0 to 3 according to how far it is from normal. The sum, or any single parameter scoring 3, sets how often to observe and who must be called. It works only if every parameter is measured well and acted on.
Reference values
- Systolic pressure: 90–139 scores 0; 140–149 scores 1; 150–159 scores 2; 160 or more scores 3.
- Diastolic pressure: under 90 scores 0; 90–99 scores 1; 100–109 scores 2; 110 or more scores 3.
- In the first 2 hours after birth, vital signs and bleeding are checked every 15 minutes.
- Postpartum fever is a temperature above 38 °C, except in the first 24 hours after birth.
How to measure it (and why)
- Measure all the parameters together with correct technique — the score needs every value.
- Score each parameter with the Annex 5 chart and add them up — a single 3 matters on its own.
- Record the score, the time and the values in the chart — the trend shows deterioration.
- Act on the response level: observation frequency and who to call — the score is useless without the response.
- When calling, give the score, the abnormal parameters and the trend — the team can prioritise.
- After birth, also check uterine tone, bleeding, bladder distension, breathlessness and chest pain — they reveal atony and embolism.
- Listen to what the woman says: a warning sign needs a response even with a low score — scores do not catch every problem.
- Repeat the score at the frequency the response level sets — a change in score changes the plan.
Response to the score (Res. 3280 de 2018, Annex 5)
| Score | Observation | Call |
|---|---|---|
| 0 | Routine | None |
| Total 1–3 | At least every 4 hours | Nurse in charge |
| One parameter at 3, or total 4 or more | At least every hour | Urgent: medical team and staff skilled in acute illness |
| Total 6 or more | Continuous vital signs | Emergency: critical care team |
How to read it
- Res. 3280 sets the emergency care for the main obstetric emergencies: haemorrhage, hypertensive disorders and sepsis.
- For sepsis, Res. 3280 uses the qSOFA and SOFA criteria alongside the clinical assessment.
- Warning signs can appear up to a year after birth: headache that will not go, vision changes, fever, trouble breathing, chest pain, heavy bleeding, thoughts of self-harm.
Next step: when to call for help
- Act according to the response table every time you score.
- Seek medical care at once for headache with vision changes, fainting, fever of 38 °C or more, severe swelling, trouble breathing or chest pain.
- Also seek care at once for severe belly pain, reduced fetal movements, bleeding or fluid loss in pregnancy, or soaking a pad in an hour after birth.
- Thoughts of harming herself or the baby: urgent assessment and do not leave her alone.
Test yourself
Think of the answer, then tap the question to see it.
What does the nurse do when one parameter of the obstetric warning score scores 3?
Observes at least hourly and calls the medical team urgently, even if the total is low.
Which parameters make up the Colombian obstetric early warning score?
Systolic and diastolic pressure, respiratory rate, heart rate, oxygen needed to keep saturation above 95 %, temperature and level of consciousness.
How often are vital signs and bleeding checked in the first 2 hours after birth?
Every 15 minutes (Res. 3280 de 2018).
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Resolución 3280 de 2018: lineamientos técnicos y operativos de la Ruta de Promoción y Mantenimiento de la Salud y de la Ruta Materno Perinatal (Anexo 5: escala obstétrica de alerta temprana) (Ministerio de Salud y Protección Social de Colombia, 2018); Urgent Maternal Warning Signs (HEAR HER campaign) (Centers for Disease Control and Prevention, 2024).
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Representative model, for educational purposes only.