Implementing Modified Early Obstetric Warning System-Based Surveillance for Intrathecal Morphine After Cesarean Delivery: A Retrospective Observational Study in a Bonding Room Model
Philipp Martin Lichtenberger, Raffaella Fantin, Hannah Vorhofer, Julia Nkechi Oji-ZurmeyerAbstract
Objective:
The aim of this study was to evaluate the feasibility, adherence, and safety of a newly implemented postoperative monitoring protocol based on the modified early obstetric warning score (MEOWS) in a dedicated bonding room following cesarean delivery with low-dose intrathecal morphine (100 μg) at the University Hospital of Innsbruck.
Material and Methods:
In this retrospective observational cohort study, 250 women were included, who underwent elective cesarean delivery under spinal anesthesia with 100 μg intrathecal morphine between April 2021 and April 2022. After surgery, patients were monitored in a bonding room located on the maternity ward, bypassing the post-anesthesia care unit. Monitoring was performed by trained nurses using a standardized MEOWS chart, including predefined escalation criteria. The primary outcome was the incidence of respiratory complications. Secondary outcomes were protocol adherence, analgesic effectiveness, and maternal adverse events.
Results:
No respiratory complications, naloxone administration, or code blue events occurred. MEOWS protocol adherence exceeded 98%. Pain scores remained low (median maximum NRS 3 [IQR 2–4]); 82% of patients required no systemic opioids. No cases of severe maternal morbidity were observed. Minor side effects were rare and self-limiting.
Conclusion:
Structured MEOWS-based monitoring in a bonding room proved feasible and safe in a selected low-risk cohort with intrathecal morphine for cesarean delivery. This model may offer a resource-conscious alternative to post-anesthesia care unit-based surveillance, enabling early maternal-newborn contact, while maintaining patient safety. Broader implementation should be supported by local adaptation, staff training, and validation in higher-risk populations.