Maternal mortality and severe maternal morbidity are a major healthcare challenge worldwide. The Maternal Mortality Rate (MMR) in India has reduced significantly in the past two decades from 356/100,000 in 1997 to 99/100,000 in 2020 [1]. However, India still contributes to one-fifth of the global maternal mortality [1], [2]. Maternal morbidity, which precedes maternal mortality, is amenable to treatment if identified early. The early identification of the severity of maternal morbidity can help to initiate appropriate therapy at an earlier stage. It also reduces the adverse consequences including progression to extremely severe conditions, near miss or maternal mortality [3]. This will also help minimize long-term health and quality of life consequences in survivors.

Eclampsia, a leading cause of severe maternal morbidity and mortality, is a life-threatening emergency with mortality rates as high as 9 % in different parts of India [4]. The incidence of eclampsia in India was reported as 1.5 %, which is 5 times higher than the global incidence of 0.28 % [4]. The higher incidence in India may be attributable to several delays including identification of severe maternal morbidity, initiating appropriate therapy, availability and affordability of therapeutic regimes, referral to appropriate centers, delay by patients to access healthcare services and logistical issues for patients including distances that must be travelled to access care which also affects compliance with follow up care schedules [4]. The Maternal Early Warning Trigger (MEWT) tool was designed to address the four major causes of maternal morbidity and mortality – hemorrhage, sepsis, hypertension in pregnancy, and cardiovascular dysfunction. The MEWT tool provides a plan of management for each condition unlike the other early warning systems [5]. The implementation of MEWT tool showed a significant reduction in eclampsia rate from 2 to 0.4 per 1000 deliveries and severe maternal morbidity rate from 2 to 1.6 % [5]. Most of the guidelines suggest magnesium sulfate prophylaxis only when a woman had imminent symptoms of eclampsia (headache, vomiting, blurring of vision, epigastric pain) or severe features which were subjective to the clinician’s decision. The MEWT tool suggests administration of magnesium sulfate when the blood pressure is recorded as 160/110 mmHg or more, requiring acute emergency management of hypertension with rapid-acting antihypertensive drugs [5].

MEWT tool was integrated with the routine clinical practice at the study institute, which is an advanced tertiary care referral institute, in 2017. The impact of MEWT tool on the rates of eclampsia at the study institute is presented in this manuscript.