Maternal Early Obstetric Warning System (MEOWS) as a Predictor of Maternal Morbidity and Mortality

Background Maternal morbidity and mortality remain significant public health concerns, particularly in resource-limited settings. Early warning score systems, such as the Maternal Early Obstetric Warning System (MEOWS), have been recommended to facilitate the timely recognition of clinical deterioration in obstetric patients. This study evaluates the utility of MEOWS in predicting maternal morbidity and mortality in a tertiary care center in India. Objectives To determine whether MEOWS “track-and-trigger” charts can serve as an effective bedside screening tool to predict obstetric morbidity and mortality in women beyond 28 weeks of gestation through six weeks postpartum. Methodology A prospective observational study was conducted in the obstetrics department of a tertiary teaching hospital. A total of 500 women (≥28 weeks of gestation or up to six weeks postpartum) were monitored using the standard MEOWS chart. Vital signs and obstetric parameters were recorded at admission and regular intervals. A MEOWS “trigger” was defined as the occurrence of one red (severely abnormal) value or any two simultaneous yellow (moderately abnormal) values. Management followed standard hospital protocols without clinical interventions dictated solely by triggers. Maternal outcomes were classified as no morbidity versus morbidity/mortality by discharge. Statistical analysis included chi-square tests to compare characteristics and outcomes, alongside calculations of MEOWS performance metrics (sensitivity, specificity, predictive values) and relative risk (RR) for physiological parameters. Results Out of 500 patients, 93 (18.6%) triggered MEOWS, while 407 (81.4%) did not. The triggered group had significantly higher proportions of advanced age, grand multiparity, urban residence, referrals, and low socioeconomic status. On admission, 71% of triggered patients presented with obstetric complications compared to only 5.4% of non-triggered patients. Obstetric outcomes revealed a stark contrast: 37.6% of triggered women required emergency intervention versus 4.4% of the non-triggered group. All 15 maternal deaths occurred in the triggered group (16.1% case fatality). Overall, 76.3% of triggered women suffered severe morbidity or mortality, compared to only 2.0% of the non-triggered group. MEOWS demonstrated high diagnostic accuracy with a sensitivity of 76.3%, specificity of 98.0%, positive predictive value (PPV) of 89.9%, and negative predictive value (NPV) of 94.8%. A positive screen was associated with an approximate 38-fold higher risk of severe morbidity. Analysis of individual parameters indicated that tachypnea was the strongest single predictor of morbidity (RR: ~19.5), followed by diastolic hypertension (RR: ~15.4) and maternal tachycardia (RR: ~13.5). Conclusion In this prospective cohort, the MEOWS “track-and-trigger” system proved to be a valuable predictor of maternal morbidity and mortality. Women breaching trigger criteria were significantly more likely to experience severe complications or death. The MEOWS chart demonstrated high specificity and strong predictive value, correctly identifying the majority of women who developed obstetric morbidity with few false alarms. These findings support the incorporation of MEOWS into routine obstetric care to facilitate the early recognition of critical illness and improve maternal outcomes.