Implementation of a modified obstetric early warning system to improve the quality of obstetric care in Zimbabwe

Abi Merriel, Bobb T. Murove, Samuel W D Merriel, Thabani Sibanda, Sikangezile Moyo, Joanna Crofts

Research output: Contribution to journalArticle (Academic Journal)peer-review

11 Citations (Scopus)
349 Downloads (Pure)


To implement a modified obstetric early warning system (MOEWS) to promote identification and stabilization of unwell women.
A before-and-after study of MOEWS implementation took place between April 2013 and January 2014 in a government referral hospital in Bulawayo, Zimbabwe. After piloting MOEWS, cesarean case files were retrospectively assessed to compare preoperative stabilization. A longitudinal “spot-check” study measured use of MOEWS and action taken on abnormal results. A quality indicator was introduced to assess ongoing implementation.

Analysis of women undergoing cesarean before (n=79) and after (n=85) MOEWS implementation showed that preoperative stabilization improved significantly post-intervention (odds ratio 2.78, 95% confidence interval 1.39–5.54). The longitudinal analysis of women at baseline (n=43) and after (n=85) MOEWS implementation also showed a significant improvement in action taken (1/24 [4%] vs 28/45 [62%]; P=0.001). The 6-month aggregated quality indicator revealed that 78 (62%) of 125 patients had a completed MOEWS chart, with appropriate stabilization of 65 (93%) of 70 women.
Implementation of MOEWS improved women's care through action being taken on abnormal observations. Before whole-scale adoption of MOEWS in low-resource settings, the study should be scaled up and repeated to ensure replicable findings.
Original languageEnglish
Pages (from-to)175-179
Number of pages5
JournalInternational Journal of Gynecology and Obstetrics
Issue number2
Early online date21 Nov 2016
Publication statusPublished - 4 Jan 2017


  • Decision support tool
  • Early warning score
  • Low-resource setting
  • Maternal health
  • Recognition of deteriorating patients


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