Dr Lucy Mackillop
Oxford University Hospitals NHS Foundation Trust
Maternity Early Warning Scores
Maternity Early Warning Scores (MEWS) are widely used throughout hospitals in the UK to highlight when additional care is needed to protect the health of the expectant mother and baby. Their implementation varies widely across the country, and the majority of MEWS have been developed by clinical consensus.
The Pregnancy Physiology Pattern Prediction (4P) Study
This prospective UK cohort study collected vital sign data (blood pressure, heart rate, respiratory rate, temperature and oxygen saturations) from 1041 women monthly during their pregnancies, intrapartum and and daily for 2 weeks postpartum.
Gestation specific reference ranges were constructed for each vital sign comprising smoothed centiles (3rd, 10th, 50th, 90th and 97th with corresponding 95% confidence intervals).
Clinical Validation
The clinical response to higher scores was developed by 30 midwives, doctors and other experts using a Delphi exercise which allowed experts to reconsider their opinions based on the anonymised opinions of others. This ensures that the new national MEWS not only identifies potential problems, but also provides clear guidance on the appropriate escalation of care.
National rollout
The new approach is being rolled out across the NHS in England with the aim that every organisation will have implemented MEWS across England by March 2026. Latest adoption figures will be presented.
References:
- Green L. et al. Gestation-specific vital sign references ranges in pregnancy. Obstetrics & Gynecology 135(3):p 653-664, March 2020.
- Green L. et al. Postpartum-specific vital sign reference ranges. Obstetrics & Gynecology 137(2):p 295-304, February 2021.