Use of the modified early obstetric warning system chart as a predictor of peri-partum obstetric morbidity in a rural teaching institute: A two-year cross-sectional study.

Abstract

The occurrence of obstetric morbidity is on the rise in developing countries. The peri-partum period is very crucial as most of the deaths occur during labour or in the first 24 hours of the post-partum period. Early recognition and treatment of disease entities leading to obstetric morbidity can be performed by the "track and trigger" system of parameters on a chart, thus preventing the obstetric morbidity and mortality. Therefore, the MEOWS chart (Modified Early Obstetric Warning System chart) was recommended by the Confidential Enquiry into Maternal and Child Health report in order to evaluate the patient at an urgent basis with timely diagnosis and treatment. We conducted an observational study in a rural tertiary care centre based in central India over the span of 2 years from September 2017 till August 2019. Physiological parameters of 1000 patients which included pregnant women in labour >28 weeks of gestation were recorded on the MEOWS chart. Trigger was defined as either one red zone (any one parameter that was markedly abnormal, with values in the red zone) or two yellow zones (when simultaneously any two parameters were moderately de-ranged with values in yellow zones). Based on trigger, patients were categorised as triggered and non-triggered groups. Further based on the obstetric morbidity during hospital stay, triggered and non-triggered groups were divided into category 1 (patients who did not have any obstetric morbidity during hospital stay) and category 2 (patients who had any obstetric morbidity during hospital stay). Out of the total 1000 patients, 24.8% patients had an abnormal MEOWS chart and were categorised into the triggered group. Out of a total of 248 patients in the triggered group, 47.5% (118) patients had obstetric morbidity during hospital stay (category 2). The MEOWS chart was found to be 85.51% sensitive and 84.92% specific with a positive predictive value of 47.58% and a negative predictive value of 97.34%. The accuracy of the MEOWS chart was 85%. It was concluded that there was a significant difference between obstetric morbidity in normal (non-triggered) and abnormal (triggered) MEOWS chart findings. The sensitivity and specificity of the MEOWS chart were high. The negative predictive value of the chart was very high. Thus, the MEOWS chart can be used as a bedside screening tool for predicting obstetric morbidity.