Evaluation of a Canadian-Adapted Modified Early Obstetric Warning System (Can-MEOWS): A Quality Improvement...

Area of Science:

• Obstetrics and Gynecology
• Maternal Health
• Quality Improvement Science

Background:

• Severe maternal morbidity (SMM) poses a significant threat to maternal health.
• Early identification of SMM is crucial for timely intervention and improved outcomes.
• Existing early warning systems require adaptation and validation for diverse healthcare settings.

Purpose of the Study:

• To assess the performance of the Canadian-adapted Modified Early Obstetric Warning System (Can-MEOWS) in predicting SMM.
• To investigate the relationship between individual Can-MEOWS parameters and the occurrence of SMM.
• To support the implementation of obstetric early warning systems in Canada.

Main Methods:

• A quality improvement study analyzing obstetric patient encounters (20 weeks gestation to 6 weeks postpartum) with documented Can-MEOWS scores.
• Log-binomial regression was used to estimate relative risks (RRs) for SMM.
• Can-MEOWS performance was evaluated using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) at various score thresholds.

Main Results:

• Among 13,756 encounters, 13.8% experienced SMM, primarily severe hemorrhage and sepsis.
• Higher Can-MEOWS scores correlated with increased SMM risk (e.g., RR 6.70 for scores ≥7).
• Tachypnea, fever, hypertension, tachycardia, and proteinuria were significantly associated with SMM; a total score ≥1 showed high sensitivity (95.4%) and NPV (93.4%).

Conclusions:

• Can-MEOWS is a dependable tool for the early detection of SMM, demonstrating high sensitivity and NPV.
• Refining score thresholds can reduce false positives and alarm fatigue.
• Broader adoption of obstetric early warning systems like Can-MEOWS is recommended to enhance maternal safety in Canadian centers.