How digital tools are helping to identify at-risk moms in labor

Dr. Narmadha Kuppuswami will be speaking at HIMSS20 about her new tool WONDER, which was developed to identify when a mother's vital signs are taking a turn for the worse during labor.
By Laura Lovett
04:17 pm

Dr. Narmadha Kuppuswami has a long history of working in women’s health. Her first experience dates back to her early medical school years in India, during her first clinical rotation.  

“I was only 18 or 19 ... [and] there was a patient and that was her sixth pregnancy,” she said. “She was transferred from a clinic with obstructed labor and a possible ruptured uterus, and doctors were scrambling to take her to the OR. I was just a medical student and I was holding her hand and standing by. She was begging and crying and saying, ‘I have five kids at home, please save me and my baby.’ She was crying and crying. I tried to reassure her but by the time they were taking me to the OR she had died.”

This early career experience left a lasting impression on Kuppuswami, who has since dedicated her career to helping prevent maternal deaths. 

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“I can close my eyes and see her face. Every time I see her face I can’t help but cry," she said. "That probably made an indelible mark on my brain. On that day I thought, 'If I’m going to be a doctor and if I can save even one mother from dying, I will have fulfilled my role as a physician.”

Since then, Kuppuswami has worked in both India and in Illinois. Her work in Chicago primarily centered around caring for African-American women, as well as women living in low socio-economic communities.

Her work has included both the clinical side of care, as well as roles on maternal mortality clinical boards. This prompted her to consider the role of technology in preventing maternal mortality. 

“The change from normal to death is very short and very steep,” she said. “When a patient goes from normal to abnormal, the first thing that changes is the vital signs. ... We have to use vital signs and come up with something. So, what we did was create a software based on vital signs.”

The new tool, dubbed WONDER, will color-code a woman’s vital signs for clinicians when she is in labor. If everything is normal, the vitals will come up as green; if there are some concerns, it will be yellow; and if the woman needs immediate help, the screen will show her vitals in red. If this occurs, then clinicians can click on the tool to see possible diagnoses for the patient based on an internal algorithm. 

“If you click on that, it will give the guidelines and what the nurse has to do," she explained. 
"It will list the medications patients will need, the dose and side effects — what are the lab orders, what are the nurse’s orders, what are the doctor’s orders. The medication dose and outcome will be at the click of a button, and if they want a reference they can go to the reference library and all of the current up-to-date references are listed there and they can look into that.”

The system will also send an alert to the blood bank that a patient is having issues and may need blood soon, allowing teams to prep for the worst.

Since creating the tool, Kuppuswami and her team have run a pilot in India. The tool was used in areas that had a shortage of doctors, and where one doctor could be treating 40 to 50 patients actively in labor. 

“If you look at the major hospital in the study, at any given time there are 40 to 50 patients in labor with one doctor on and two or three nurses at the maximum,” she said. “When the doctor comes in, unless the doctor sees all of the 50 patients she is not going to figure out who is sick and who is not sick.”

The end goal is to get the right care to the right patients. She said that while this tool was piloted in India, she could see uses for it in other locations, such as Native American reservations, which are often far from major hospitals. 

“We’ve made it easy for doctors to identify who are the sickest patients,” she said.  

Dr. Narmadha Kuppuswami will be talking about her experience implementing the WONDER pilot at HIMSS20 at the session “Technology Helping Reduce Maternal Mortality and Morbidityon Wednesday, March 11, from 10 to 11 a.m. in room W300. 


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