What is the Modified Early Obstetric Warning System (MEOWS) chart?

From the Guidelines

The Modified Early Obstetric Warning System (MEOWS) chart is a tailored chart used for the physiological monitoring of pregnant women, taking into account the different normal ranges for maternal vital signs compared to the general population 1.

Key Components of MEOWS

• The MEOWS chart is designed to aid in the early detection of potential complications in pregnant women, such as pre-eclampsia, pre-term delivery, and postpartum haemorrhage 1.
• It typically includes parameters such as:
  • Systolic and diastolic blood pressure
  • Heart rate
  • Oxygen saturation
  • Urine output (oliguria)
  • Maternal agitation, confusion, or unresponsiveness
  • Non-remitting headache in patients with hypertensive disease of pregnancy
  • Shortness of breath

Evidence Supporting MEOWS

The use of MEOWS is supported by studies that highlight the importance of early warning systems in identifying women at risk of maternal morbidity and mortality 1.

• A study found that the use of a 3-part risk score, which incorporates medical and non-medical factors, can help assess the antenatal risk of severe maternal morbidity (SMM) among pregnant patients 1.
• Another study suggested that the use of the modified Obstetrical Comorbidity Index (OB-CMI) can help assess the risk of SMM and can be used in conjunction with physiological screening tools like MEOWS 1.

Clinical Application of MEOWS

In clinical practice, the MEOWS chart can be used to monitor pregnant women and identify those who may be at risk of developing complications.

• The chart can help healthcare providers to quickly identify abnormal vital signs and take prompt action to prevent or manage complications 1.
• The use of MEOWS can be particularly useful in high-risk pregnancies, such as those with pre-existing medical conditions or pregnancy-related complications 1.

From the Research

Definition and Purpose of MEOWS Chart

• The Modified Early Obstetric Warning System (MEOWS) chart is a risk stratification tool designed to predict severe maternal morbidity and mortality 2, 3, 4.
• The MEOWS chart is based on the principle that abnormalities in physiological parameters precede critical illness, and its purpose is to identify patients at risk of severe outcomes early in their hospital visit 3.

Components and Scoring of MEOWS Chart

• The MEOWS chart includes various physiological parameters, such as vital signs, that are tracked and scored to identify potential risks 3, 5.
• A trigger is defined as a single markedly abnormal observation (red trigger) or the combination of two simultaneously mildly abnormal observations (two yellow triggers) 3.

Validation and Performance of MEOWS Chart

• Studies have validated the performance of the MEOWS chart in predicting obstetric morbidity, with reported sensitivities ranging from 72.91% to 86.4% and specificities ranging from 67.9% to 91.87% 2, 3, 4.
• The MEOWS chart has been compared to other early warning scores, such as the Modified Early Warning Score (MEWS) and the National Early Warning Score (NEWS), and has been found to be more accurate in predicting deterioration and infection in obstetric patients 5.

Clinical Application and Benefits of MEOWS Chart

• The MEOWS chart can be used as a bedside screening tool for predicting obstetric morbidity and identifying patients at risk of severe outcomes 3, 4.
• The use of the MEOWS chart can help healthcare providers recognize maternal morbidity at an early stage, ultimately reducing the risk of severe maternal morbidity and mortality 2, 3, 4.