A new modified obstetric early warning score for prognostication of severe maternal morbidity

Abstract

Background Maternal mortality is still a major challenge for health systems, while severe maternal complications are the primary causes of maternal death. Our study aimed to determine whether severe maternal morbidity is effectively predicted by a newly proposed Modified Obstetric Early Warning Score (MOEWS) in the setting of an obstetric intensive care unit (ICU). Methods A retrospective study of pregnant women admitted in the ICU from August 2019 to August 2020 was conducted. MOEWS was calculated 24 h before and 24 h after admission in the ICU, and the highest score was taken as the final value. For women directly admitted from the emergency department, the worst value before admission was collected. The aggregate performance of MOEWS in predicting critical illness in pregnant women was evaluated and finally compared with that of the Acute Physiology and Chronic Health Evaluation II (APACHE II) score. Results A total of 352 pregnant women were enrolled; 290 women (82.4%) with severe maternal morbidity were identified and two of them died (0.6%). The MOEWSs of women with serious obstetric complications were significantly higher than those of women without serious obstetric complications [8(6, 10) vs. 4(2, 4.25), z = -10.347, P < 0.001]. MOEWSs of 24 h after ICU admission had higher sensitivity, specificity and AUROC than MOEWSs of 24 h before ICU admission. When combining the two MOEWSs, sensitivity of MOEWS was 99.3% (95% CI: 98–100), specificity 75.8% (95% CI: 63–86), positive predictive value (PPV) 95.1% (95% CI: 92–97) and negative predictive value (NPV) 95.9% (95% CI: 86–100). The areas under the receiver operator characteristic (ROC) curves of MOEWS were 0.92 (95% CI: 0.88–0.96) and 0.70 (95% CI: 0.63–0.76) of the APACHE II score. Conclusion The newly proposed MOEWS has an excellent ability to identify critically ill women early and is more effective than APACHE II. It will be a valuable tool for discriminating severe maternal morbidity and ultimately improve maternal health.

Predictores de muerte materna en pacientes gestantes

“…Los análisis de las muertes maternas han revelado consistentemente que los retrasos en el reconocimiento de las complicaciones del embarazo están asociados con una mayor mortalidad 9 . Los signos vitales que indicaban enfermedad cardíaca y hemorragia postparto no eran significativamente anormales en las primeras etapas debido a los cambios fisiológicos del embarazo.…”

“…Las intervenciones comprobadas para controlar estas causas deben estar disponibles en los establecimientos de salud. Las diferencias espaciales observadas en las muertes maternas en un área geográfica relativamente pequeña exigen un estudio integral de métodos mixtos para comprender las causas 20 .…”

Comparison of the efficacy for early warning systems in predicting obstetric critical illness

“…Since there is no uni ed early warning system for obstetrics, and the parameters setting of each scoring system are disparate. A Modi ed Obstetric Early Warning Score (MOEWS) was constructed by our team recently [14]. We combined the advantages of color warning and weighted scoring system`, then readjusted parameter thresholds, and added new criteria for pregnancy with heart disease as well as severe postpartum hemorrhage.…”

Evaluating Effectiveness of MEOWS Tool in Identifying Maternal Deterioration in Women Receiving Care among Nurses in Maternity Unit, at General Hospital, Dammam

“…In theory, triggering the MEOWS system could enable early detection of diseases such as cardiovascular disease, sepsis, thromboembolic disease, hemorrhage, and pre-eclampsia that can increase maternal morbidity and mortality (Norfolk University and Norwich University Hospital MEOWS Guidelines, 2022). It is well known that pregnant women are at risk of obstetric emergencies at all stages of life, including before, during, and postpartum (Xu et al, 2022). To prevent adverse maternal outcomes due to delays or errors in maternal management, it is important that all midwifery staff understand 'early warning signs' and be able to assess maternal clinical status using the MEOWS tool (Umar et al, 2019).…”