The document discusses Modified Early Obstetric Warning Scores (MEOWS), which were introduced in the UK to decrease maternal mortality by improving early detection of clinical deterioration in pregnant women. MEOWS involves routinely monitoring and recording vital signs and assigning a score based on abnormalities, with higher scores triggering more urgent review. It is a standardized screening tool used to assist in early recognition of physiological signs of deterioration and intervention for at-risk pregnant women. Regular MEOWS assessments performed by trained midwives can help identify issues earlier before signs worsen and improve outcomes.

1. MODIFIED EARLY OBSTETRIC WARNING SCORE
(MEOWS)
Dr. Latha Venkatesan
Principal, College of Nursing, AIIMS, Delhi

2. INTRODUCTION
Modified Early Warning Score (MEOWS)
was introduced to obstetric units in the
United Kingdom to decrease maternal
mortality by improving early detection of
clinical signs of deterioration in women who
were developing critical illnesses.

3. MEOWS
• Early warning systems involve the routine
monitoring and recording of vital signs or
clinical observations on specifically designed
charts with linked escalation protocols.
• Meeting criteria for abnormal physiological
parameters triggers a color‐coded or weighted
scoring system aimed to guide the frequency
of monitoring, need for, and urgency of clinical
review.

4. EARLY WARNING SYSTEM (EWS)
• Early warning systems physiologic
“track and trigger” systems are
clinical prediction models that
involve serial clinical observations
(“track”) with criteria (“trigger”) to
identify patients at risk of
complications.

5. HOW EARLY WARNING SCORE WORKS????

6. EWS- WHO IS IT USED FOR??

7. DIFFERENT TYPES OF WARNING SCORE

8. MODIFIED EARLY WARNING SCORE (MEWS)
• An evidenced-based organized screening
tool with aggregated scoring of “multiple”
pre-determined indicators to assist in early
recognition and intervention of physiologic
signs of patient deterioration.
• Temperature
• Heart rate
• Blood Pressure
• Respiratory rate
• Level of consciousness

9. MEWS SCORING CHART (FOR ADULT)

10. PEDIATRIC EARLY WARNING SCORE (PEWS)

11. PEWS SCORING CHART

12. MODIFIED EARLY OBSTETRIC WARNING SCORES
(MEOWS)
• MEOWS is a simple, quick-to-use tool based
on routine physiological observations.
• The scoring of these observations can provide
an indication of the overall status of the
patient’s condition.
• Prompt action and urgent medical review when
indicated, allow for appropriate management
of women at risk of deterioration.

13. WARNING SIGNS IN OBSTETRICS

14. THREE MAIN COMPONENTS OF MEOWS
Urgency
of clinical
Review
Frequency of
Monitoring
Competen
cy Team

15. When to use the maternity early warning scoring
system
All women in active labour and following delivery
All antenatal admission to hospital
All postnatal admission to hospital
If any health problem is suspected
If the mother ever reports feeling unwell

16. WHO SHOULD PERFORM MEOWS
• This will usually be performed by Midwives
• It may also be performed by Maternity Care Assistants providing
they have undergone the appropriate training
• It may also be performed by student midwives under the
supervision (direct/indirect) of the midwife mentoring them providing
they have been assessed competent to do so.

17. MEOWS OBSERVATION FOR ALL WOMEN
• MEOWS chart first page
• Temperature ( 4TH hourly)
• Pulse, Respiration, BP • Partograph
• FHR ¼ hourly
• PV - 4th hourly
• Contractions frequency-30 mts
• Amniotic fluid record hourly
• Maternal pulse hourly
• MEOWS chart second page
• Urine output
• Neuro response
• Pain score
• Lochia
• Looks unwell

18. MEOWS SCORING CHART

19. DETERIORATING OBSTETRIC PATIENT ESCALATION
ALGORITHM

20. TRIGGERING ON MEOWS
A trigger is defined as a single markedly abnormal observation
(red trigger), or the combination of two simultaneous mildly
abnormal observations (two amber triggers).
Low score: 1-4 can be attended by registered nurse ( Green)
Medium Score: 5-7 can be attended by ward level doctor/Acute
care nurse ( Amber)
High score: >7 can be attended by critical care team (Red)

21. TRIGGERING ON MEOWS

22. TRIGGERING ON MEOWS

23. TRIGGERING ON MEOWS CHART
Referral
Monitoring
Review
Investigation
Plan of care
It is important
to remember
when the
woman
triggers she
requires

24. Actions to take when a woman is Triggering on the
MEOWS Chart
• Inform the labour ward co coordinator.
• Make sure you have all the information you need to hand notes, charts,
blood results.
• State the current problem giving the observation findings and state which
ones are triggering.
• If raised systolic or diastolic report any prodomal signs such as
headache, nausea, vomiting, upper epigastric pain.
• Be clear about your expectations of the clinician that the woman requires
a bedside review in less than 10 minutes.

25. Actions to take when a woman is Triggering on the
MEOWS Chart
• Increase observation frequency to ¼ hourly.
• Explanation of plan of care to the woman and relatives.
• Monitor saturation levels.
• Give O2 via face mask if required assess patent airway, is the woman
awake and talking.
• Check IV lines are running
• Check the drug chart and ensure medications have been administered,
report time of delay of any drugs especially anti hypertensive.
• Maintain contemporaneous record in notes detailing plan of care

26. MEOWS UPDATE FOR STAFF
• Staff training requirement –Yearly update on maternal BLS and MEOWS
on mandatory training programme.
• MEOWS Chart compliance will be audited using the attached MEOWS
audit charts

27. •

28. OUTCOME OF MEOWS
• Maternal deaths are decreasing and evaluation is ongoing.
• MEOWS is an innovative approach to care in the field of obstetrics.
• In a validation study, MEOWS had high sensitivity in predicting morbidity
(89%) and reasonable specificity (79%) supporting its use for obstetric
patients.
• MEOWS can be paper-based or used as part of an electronic medical
record and provides a standardized approach to the assessment of
maternal well-being.
• It has been incorporated into the rapid response policy, which ensures
clarity of staff roles and responsibilities.

29. TAKE HOME MESSAGE

30. MEOWS SYSTEM WILL WORK ONLY IF
Staffs are trained in MEOWS
Response system and staffs are in
place to deliver care
Measure and record the system for
each parameters
Aggregate the score and add 2 if O2
supplemented

31. • Modified early obstetric warning scores:
A promising tool but more evidence and
standardization is required
DRAWBACKS OF MEOWS

32. CONCLUSION
• MEOWS score helps in early recognition of altered physiological
parameters in pregnant mothers, before signs and symptoms
become clinically evident as disease process worsens.
• This helps in early identification of pregnant mothers who require
referral to higher care centres for expertise care and/or for clinical
intervention.