The Role of Early Warning System in Predicting Severe Maternal MorbidityTaking Intensive Care Unit Admission as the Reference Standard

Sidra Mahmood Malik; Shahida Sheraz; Hidayat Ullah; Rabea Al Hassan; Andaleeb Ara

doi:10.51253/pafmj.v73i5.7385

Authors

Sidra Mahmood Malik Department of Obs & Gynae, Combined Military Hospital Abbottabad/National University of Medical Sciences (NUMS) Pakistan
Shahida Sheraz Department of Obs & Gynae, Abbottabad International Medical College, Abbottabad Pakistan
Hidayat Ullah Department of Radiology, Frontier Medical & Dental College, Abbottabad Pakistan
Rabea Al Hassan Department of Obs & Gynae, Combined Military Hospital Abbottabad/National University of Medical Sciences (NUMS) Pakistan
Andaleeb Ara Department of Paediatrics, Armed Forces Institute of Cardiology/ National Institute of Heart Disease/National University of Medical Sciences (NUMS) Rawalpindi Pakistan

DOI:

https://doi.org/10.51253/pafmj.v73i5.7385

Keywords:

Early warning score, Intensive care unit, Modified early warning system (MEOWS), Obstetrics and gynaecology

Abstract

Objective: To determine the diagnostic accuracy of a modified early warning system (MEOWS) for predicting severe maternal morbidity, taking intensive care unit admission as the reference standard.

Study Design: Cross-sectional study.

Setting and Duration of Study: Combined Military Hospital, Abbottabad Pakistan, from Nov 2019 to Apr 2020.

Methodology: After getting approval from the Institutional Ethical Committee, pregnant women fulfilling the inclusion
criteria were included from the Labour Room of Department of Obstetrics & Gynecology. A modified early obstetric warning system chart was used to assess all women, labelling them positive or negative as per the criteria. In case of a fatal outcome or development of severe morbidity warranting intensive care unit admission, the patient was labelled as positive. Women who developed severe morbidity were managed as per standard protocols.

Results: The early warning chart showed sensitivity, specificity, positive predictive value, negative predictive value and
diagnostic accuracy as 69.44%, 90.97%, 64.10%, 92.76% and 86.91%, respectively, for predicting severe obstetric morbidity
considering intensive care unit admission as gold standard.

Conclusion: Modified early obstetric warning system chart effectively predicts severe obstetric morbidity. It could lead to
better patient care, thus preventing severe obstetric morbidity in our local population if implemented as part of routine clinical evaluation.