Modified Early Obstetric Warning Criteria Predict Maternal Morbidity in the Immediate Postpartum Period: A Case–Control Study

Objective

To evaluate the application of Modified Early Obstetric Warning Criteria (MEOWC) in the immediate postpartum period and to generate a preliminary predictive model for postpartum maternal morbidity.

Design

Retrospective case–control study that was conducted from January 2017 to January 2020. A total of 2,762 births occurred during the study period.

Setting

Obstetrics unit of a general hospital located in the Nakhon Si Thammarat province of Thailand.

Participants

Three hundred charts of complete health records for women in the first 24 hours postbirth were used in the study. Severe maternal morbidity indicators from the Centers for Disease Control and Prevention as well as corresponding International Classification of Diseases, 10th Revision–Clinical Modification codes during birth and postpartum hospitalizations were used to define maternal morbidity. Case and control individuals were matched in an approximate 1:2 fashion based on the year when the birth occurred.

Measurements

Outcomes measurement was carried out using three data record forms—personal data, obstetric history, and MEOWC. To estimate the risks, logistic regression was performed, and a receiver operating characteristic curve was derived to evaluate the model’s performance.

Results

One hundred cases of maternal morbidity that occurred in the immediate postpartum period were identified and matched with 200 control cases. Women with MEOWC during the immediate postpartum were much more likely to experience subsequent postpartum maternal morbidity than were women without the criteria. MEOWC were a moderate predictor of postpartum maternal morbidity.

Conclusion

MEOWC are associated with increased odds of postpartum maternal morbidity. However, these findings should be validated in a prospective cohort to develop a predictive model that is effective for use in immediate postpartum care.