MEOWS Calculator

Modified Early Obstetric Warning Score for detecting maternal deterioration in pregnancy and postpartum.

Important Clinical Disclaimer: MEOWS Calculator is intended for use by qualified healthcare professionals only. It is for educational and informational purposes and should not replace clinical judgement. Always interpret results alongside the full clinical picture and follow your local guidelines and protocols.
Vital Signs
Obstetric Parameters
Unrelieved by standard analgesia
Additional Clinical Concerns
About MEOWS
Background

MEOWS (Modified Early Obstetric Warning Score) was developed following recommendations from MBRRACE-UK confidential enquiries into maternal deaths. It recognises that standard early warning scores (like NEWS2) are not appropriate for pregnant women due to the normal physiological changes of pregnancy.

Why Use MEOWS?
  • Pregnant women have different normal vital sign ranges
  • Standard NEWS2 may not detect deterioration appropriately
  • Includes obstetric-specific parameters
  • Supports the recognition of sepsis, haemorrhage, and pre-eclampsia
Normal Pregnancy Changes
  • Blood pressure: Decreases in 1st/2nd trimester, returns to normal by term
  • Heart rate: Increases by 10-20 bpm
  • Respiratory rate: Slightly increased
  • Temperature: May be slightly elevated
UK Implementation

NHS England recommends that all maternity services implement a modified obstetric early warning system. The specific MEOWS chart may vary between trusts, but the principles remain consistent with national guidance.

Frequently Asked Questions

MEOWS (Modified Early Obstetric Warning Score) is an early warning scoring system specifically designed for pregnant and postnatal women. It accounts for the normal physiological changes of pregnancy and helps identify women who are deteriorating and need urgent medical review.

MEOWS is specifically adapted for obstetric patients, accounting for normal pregnancy changes such as lower blood pressure and higher heart rate. NEWS2 parameters are based on non-pregnant adults and may not be appropriate for pregnant women. MEOWS also includes obstetric-specific triggers like lochia and pain assessment.

A single red trigger or two or more amber triggers should prompt immediate medical review. Red triggers indicate severe abnormality requiring urgent senior clinician involvement. Amber triggers indicate moderate concern requiring increased monitoring and clinical review within 30 minutes.

MEOWS should be used for all pregnant women from 20 weeks gestation and up to 6 weeks postpartum who are admitted to hospital or receiving care in a clinical setting. It should be recorded at least every 12 hours, or more frequently if clinically indicated.
References
  1. Knight M, et al. (Eds). Saving Lives, Improving Mothers' Care - Lessons learned to inform maternity care. MBRRACE-UK. MBRRACE-UK
  2. Singh S, McGlennan A, England A, Simons R. A validation study of the CEMACH recommended modified early obstetric warning system (MEOWS). Anaesthesia. 2012;67(1):12-18. PMID: 22066604
  3. NHS England. Saving Babies' Lives Care Bundle Version 2. 2019. NHS England
  4. NICE Guideline CG192. Antenatal and postnatal mental health. National Institute for Health and Care Excellence. NICE CG192
Trigger Key
RED Trigger

Severe abnormality - urgent senior review required

AMBER Trigger

Moderate concern - increased monitoring, review within 30 mins

GREEN (Normal)

Within normal parameters for pregnancy

Escalation
Immediate escalation if:
  • Any RED trigger
  • ≥2 AMBER triggers
  • Staff/patient concern
Increased monitoring if:
  • Single AMBER trigger
  • Review within 30 minutes
  • Repeat observations in 30-60 mins
Thresholds
Parameter Amber Red
RR 21-24 ≤10 or ≥25
SpO2 94-95% <94%
Temp 35.1-36.0 or 37.5-38.0 ≤35 or ≥38.1
Systolic 150-159 or 90-100 ≥160 or <90
Diastolic 90-99 ≥100
HR 100-119 or 50-59 ≥120 or <50
AVPU V P or U
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Disclaimer

This calculator is provided for educational and informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

  • Always seek the advice of a qualified healthcare provider with any questions regarding a medical condition.
  • Never disregard professional medical advice or delay seeking it because of information from this tool.
  • Clinical decision-making should always incorporate the full clinical context, patient preferences, and local protocols.
  • The creators of this tool accept no liability for decisions made based on its output.

If you are a patient: please discuss any results with your healthcare provider. This tool is designed for use by medical professionals and may not be appropriate for self-assessment.