Published in PLOS One on 2026-08-14, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Saba Desta Tessema, Mesfin Tadese, Solomon Hailemeskel, Chaltu Takele Mule, Getaneh Dejen Tiche, Lidya Asalefew Mekonnen, Getnet Mitike Kassie
Source: PLOS One • DOI 10.1371/journal.pone.0356105
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Maternal mortality in Ethiopia remains high, while most of these deaths are preventable. Early detection of deterioration and prompt response are essential to reduce these preventable deaths. The Maternal Early Warning System (MEWS) is a reliable clinical tool for this purpose. However, its effectiveness is underexplored and its bedside use is inconsistent. This study evaluated the MEWS model for predicting and reducing severe maternal outcomes.
A parallel, quasi-experimental study design was conducted among 1138 obstetric inpatients at four public hospitals of North Shewa Zone, Ethiopia. The recruitment period was from 05/05/2025–31/8/2025. The intervention group (n = 569) was monitored using the MEWS chart, which included vital signs, oxygen saturation, urine output, consciousness, and pain, and for the postpartum women; vaginal bleeding, uterine contraction, and perineal tear, were categorized as Green, Yellow, or Red. The control group (n = 569) received the standard clinical monitoring. A multivariate generalized estimating equation (GEE) model with Poisson regression was used to compare the outcomes and estimate adjusted risk ratios (aRR) with 95% confidence intervals.
The mean duration from admission to the first trigger was shorter by 4.7 hours (5.61 vs. 10.27 hours), trigger to physician evaluation by 22.6 minutes (49.3 vs. 71.9 minutes), and trigger to clinical intervention by 11.3 minutes (14.6 vs. 25.9 minutes) among women in the intervention group. Women also underwent fewer ultrasound scans (1.32 vs. 2.30) and had a shorter hospital stay by about 0.5 days (4.83 vs. 5.29 days). Women monitored with the MEWS chart had a 20% lower risk of severe maternal outcomes (aRR = 0.85, 95% CI: 0.73–0.99). Additionally, MEWS-monitored women were 9% more likely to be triggered for timely clinical response (aRR = 1.15, 95% CI: 1.03–1.28).
Implementation of the MEWS was associated with earlier detection of maternal deterioration, shorter clinical response, fewer ultrasound investigations, shorter hospital stays, and lower severe maternal outcomes. Further studies with larger number of clusters are needed to evaluate the effectiveness of MEWS across different risk groups and settings.
Pan African Clinical Trial Registry (PACTR), PACTR202506739780428, https://pactr.samrc.ac.za
Introduction
Despite a 34% global decline in maternal mortality from 2000 to 2020, an estimated 287,000 women still died in 2020, with 95% of these deaths occurring in low-income countries, including Ethiopia [1]. In Ethiopia, the maternal mortality ratio declined from 871 per 100,000 live births in 2000–267 in 2020 [2], but this remains far above the Sustainable Development Goal target of 70 per 100,000 [3]. Beyond mortality, the World Health Organization (WHO) estimates that for every maternal death, 20–30 women experience maternal morbidity, underscoring the magnitude of the problem [4]. Nearly three-quarters of maternal deaths are attributable to hemorrhage, infections, hypertensive disorders, delivery complications, and unsafe abortion, conditions that are largely preventable with timely detection and intervention [4,5].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider hospital systems desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Saba Desta Tessema, Mesfin Tadese, Solomon Hailemeskel, Chaltu Takele Mule, Getaneh Dejen Tiche, Lidya Asalefew Mekonnen, Getnet Mitike Kassie. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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