(1131) Categorizing the cause of maternal instability with MEOWS

Friday, January 31, 2025

4:00 PM – 6:00 PM

Submitting Author and Presenting Author(s)

Nicholas W. Racchi, DO (he/him/his)

Resident Physician
Trihealth
Cincinnati, Ohio, United States

Coauthor(s)

KK

Kourosh Kiyani, MS

Research Statistician
TriHealth
Cincinnati, Ohio, United States
WS

William Schnettler, MD

Perinatologist
TriHealth
Cincinatti, Ohio, United States

Objective: To investigate the ability of a customized MEOWS (Modified Early Obstetric Warning System) calculator to categorize the cause of maternal critical illness.

Study Design: This retrospective self-controlled cohort study evaluated all pregnant people admitted to an intensive care unit at two separate delivering hospitals in Cincinnati, Ohio, between January 1, 2018, and August 1, 2023. Inclusion required study participants to be at least 20 weeks’ gestation through 6 weeks postpartum. Vital signs obtained within the 4 hours prior to the decision for ICU admission were compared to participants’ prior vitals from earlier triage visits. These values were then put into a customized MEOWS calculator (Figure 1) that incorporated additional history-based questions to categorize the patient into a MEOWS subset (stable, hypertensive emergency, hemorrhage, cardiac/possible peripartum cardiomyopathy, sepsis, trauma, or not otherwise classified). The calculated MEOWS category was then compared to the final discharge diagnosis to determine accuracy using Exact Methods.

Results: Vital signs from 87 patients were obtained and used in the modified MEOWS calculator. Our modified MEOWS calculator could predict maternal instability with a sensitivity of 93.3% and a specificity of 83.3%. The calculator was able to correctly categorize the cause of maternal morbidity with a sensitivity of 89.8% and a specificity of 67.8%. The individual sensitivities and specificities for the individual categories of the cause of maternal morbidity can be seen in table 1.

Conclusion: The use of a modified MEOWS calculator can better help determine the cause of maternal instability. This type of modified MEOWS calculator could better help categorize the cause maternal instability and thus allow for the effective use of an appropriate clinical protocol.