VALIDATION OF A MODIFIED OBSTETRIC EARLY WARNING SYSTEM FOR PREDICTING SEVERE MATERNAL OUTCOME AT A TERTIARY REFERRAL FACILITY IN WESTERN KENYA

Abstract

Background: Maternal ‘near-miss’ and deaths, together termed severe maternal outcome(SMO) follow a pattern of deterioration that can be predicted and prevented. To prevent SMO, a Modified Early Obstetric Warning System (MOEWS) for tracking significant changes (‘triggers’) in vital signs among obstetric patients and initiating corrective measures is suggested.

Objective: To determine predictors of SMO and the validity of the MEOWS for predicting SMO at Moi Teaching and Referral Hospital (MTRH), Eldoret-Kenya

Methods: A retrospective cohort study was conducted at MTRH among 3200 mothers admitted from 1^st January 2019. Maternal mortality and ‘near miss’ were determined by WHO criteria. Mothers were grouped into two outcome groups; either experiencing or not experiencing SMO. Their vital signs 24 hours prior to either outcome were then tabulated on a MOEWS chart and determined whether they met a vital sign trigger threshold. The sensitivity, specificity, positive predictive value(PPV) and negative predictive value(NPV) were determined. Relationship between sociodemographic and obstetric characteristic and SMO was determined by multivariate analysis

 Results: The sociodemographic and obstetric predictors of SMO were age over 35 years(aOR=1.56), having a previous caesarean delivery(aOR=2.19), caesarean delivery in the index pregnancy(aOR=2.09), being a referral(aOR=3.43), not attending antenatal care (aOR=2.53) and admission in the preterm period(aOR=2.81) and in the postpartum period(aOR 51.3). The sensitivity of MOEWS was 77%, specificity 98%, PPV 61% and NPV 98%.

Conclusion: The MOEWS chart has a high specificity, sensitivity and NPV but low PPV. The MOEWS chart is a valuable tool for predicting SMO