Modified early obstetric warning system as a predictor of maternal morbidity in Papua New Guinea: a prospective study in Alotau Provincial Hospital

Introduction Maternal mortality remains a significant global health issue, particularly in low- and middle-income countries (LMICs) like Papua New Guinea (PNG), where the maternal mortality ratio (MMR) remains high. The Modified Early Obstetric Warning System (MEOWS), a track-and-trigger tool, has been adopted internationally to facilitate early detection of obstetric complications. This study aims to validate MEOWS as a tool for predicting maternal morbidity, emergency interventions and mortality in a resource-limited setting at Alotau Provincial Hospital in PNG. Methodology This prospective observational study was conducted at Alotau Provincial Hospital over 17 months (July 2018 to November 2019). All pregnant women between 20 weeks of gestation and 6 weeks postpartum who required inpatient care were included. The MEOWS chart was used to monitor physiological parameters, triggering alerts for potential morbidity. The primary outcomes were maternal morbidity, emergency interventions, and mortality. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated to assess the tool’s effectiveness. Results A total of 676 MEOWS charts were analysed. Of these, 145 women (21%) triggered an alert. Women who triggered alerts had a significantly higher risk of developing obstetric morbidity (20% vs < 1%, P < 0.0000001), requiring high dependency unit (HDU) admission (19% vs < 1%, P < 0.0000001), and experiencing maternal death (8% vs < 1%, P < 0.0000001). The most common morbidities were hypertensive disorders (40%), haemorrhage (27%), and maternal sepsis (27%). The overall sensitivity and specificity of the MEOWS chart were 97%, with a PPV of 88% and NPV of 99%. Conclusion The MEOWS chart demonstrated high sensitivity and specificity in predicting maternal morbidity in a low-resource setting. The tool successfully identified women at risk of severe complications, including maternal death. These findings support the implementation of MEOWS in similar resource-limited settings, where timely interventions could significantly reduce maternal morbidity and mortality.