Modified Early Obstetric

Warning System (MEOWS)

Ns Deny Rakhmawati.Skep.M.Kep.Sp.Kep.M
Pengertian

 Modified Early Obstetric Warning System (MEOWS)adalah:

 Suatu sistem yg dirancang sbg peringatan dini dan panduan pada intervensi kritis
 Sistem penilaian kumulatif terhadap perubahan tanda-tanda vital
 Mendeteksi perburukan kondisi pasien menjadi dasar mengaktifkan sistem
kegawatan yg terjadi pada pasien
 What are Early Warning Signs?
Early warning signs are
“ . . . a set of predetermined
‘calling criteria’ (based on
periodic charting of vital
signs) as indicators of the
need to escalate monitoring
or call for assistance
". . . satu set yang telah
ditentukan untuk 'memanggil
kriteria' (berdasarkan chart
berkala tanda - tanda vital)
sebagai indikator kebutuhan
untuk meningkatkan pemantauan
atau meminta bantuan
 Sistem Kewaspadaan Dini
Membantu mengenali dan
mengelola tanda – tanda Keterlambatan diagnosa
perburukan pada pasien dilengkapi berkontribusi pada
dengan pengkajian klinis sehingga besarnya kematian pada
dapat mengambil keputusan yg ibu dan bayi dan
tepat bagi pasienpengkajian klinis seharusnya dapat dicegah
dan
pengambilan keputusan yang terampil.
MEOWS DIBUAT DENGAN TUJUAN

1. Mengurangi morbiditas dan mortalitas maternal

2. Untuk memperbaiki outcome kesehatan Ibu hamil dan
postpartum
3. Mengidentifikasi pasien yang berisiko untuk mengalami
perburukan
4. Memudahkan perawat dalam membuat rencana asuhan
keparawatan yg berkelanjutan
Perubahan Hemodinamik pada saat Kehamilan

 Kehamilan yang terjadi pada seorang wanita

terjadi perubahan fisiologis yang dramatis
 Sehingga mempengaruhi hampir seluruh sistem
organnya
 Kehamilan adalah kondisi dmana terjadi
perubahan’High - Flow/Low-Resistence”
 Perubahan Hemodinamik pada saat Kehamilan
(Emergency Summit,2015)
PARAMETER KEHAMILAN INPARTU DAN PASCA-
HEMODINAMIK NORMAL PERSALINAN PERSALINAN

Volume darah ↑ 20%-50% ↑ ↓

(Auto Deuresisi)
Denyut jantung ↑ 10-15 denyut/menit ↑ ↓

Cardiac Ouput (CO) ↑ 30%-50% diatas ↑ tambahan 50% ↓

baseline
Tekanan Darah ↓10 mmHg ↑ ↓

Stroke Volume (SV) ↑(300-500ml/kontraksi) ↓

↑ 30%
Resistensi Vaskuler ↓20% ↑ ↓
sistemk
 PERHATIAN PENTING
 Ibu hamil dapat kehilangan > 35% dari
blood volume sebelum muncul takikardia,
hipotensi, dan tanda-tanda hipovolemia
Lainnya
 Pada kondisi ibu yang terlihat
stabil, mungkin janin sudah
mengalami syok
 Panduan dan proses untuk deteksi
dini kondisi yang mengancam
kehidupan pada masa kehamilan
sampai 42 hari post natal
(O’Connor, Reid, 2010)

MEOWS
Suatu metode monitoring untuk
mendeteksi perubahan kondisi
pasien maternitas secara dini
When to use the maternity early warning scoring system
MEOWS assessments must be undertaken and documented, regardless of location,
on initial
assessment and thereafter 12 hourly or as indicated by the score, for:

 All women in active labour and all wamen fallowing delovery.Routine intrapartum
observations shoul alsobeperformen as per the intrapartum care guideline
 All antenatal admission to hospital
 All postnatal admission to hospital
 All in-patient to haveon going MEOSS assesment,regardless of/ stay( see below)
 All non – routine and/or non-scheduled contacts,either antenatal or postnatal.
 If any health problem is suspected at any time.
 If the mother ever reports feeling’unwell”
Who should perform MEOWS:

 This will usually be performed by Nurse/Midwives

1. It may also be performed by Maternity Care Assistants providing they
have undergone the
2. Appropriate training as per the Training Needs Analysis
3. It may also be performed by student midwives under the supervision
(direct/indirect) of the
4. Nurse/Midwife mentoring them providing they have been assessed
competent to do so
 The Scoring System: Parameters
 Scoring is based on the following parameters:

SCORE 3 2 1 0 1 2 3

Temperatur   ≤ 35 35.1-36 36,1- 37,9 38-38,4 ≥38.5  

>160
Systolic BP ≤ 70 71-90 91-99 100-130 131-139 140-160

>110
Diastolic BP     ≤ 49 50-89 90-99 100-109

>130
Pulse   ≤ 40 41-59 60-100 101-110 111-129

*≤10 11 s/d 20 21-25 26-30 >30

Respiratory Rate    

New
Conscious Level A ALERT V Respons to Voice P.(Respons to pain) U(Unconsiouse)
agitation/confusion

   
The Scoring System: Actions (Dr to review if
any RED scores)
SCORE 0  Repeat in twelve hours for all in patients
 Community assessment for non-scheduled contact, score of 0and
NO other risk factors / indications: repeat not necessary.
 Exercise professional judgement and document rationale
SCORE 1-2  Refer to Qualified/Registered Professional
 Midwife devises plan & documents when to repeat (i.e. in 1 hour / 4
hours / 12 hours)
 Continue with at least 12 hourly observations
SCORE 1-2  Refer to Qualified/Registered Professional
 Increase frequency of observations to 4 hourly
 Consider need to increase frequency of observations to Intervals of
less than 4 hours
Score 3 within 1  Refer to Qualified/Registered Professional to re-check observations
parameter:  Observation frequency increased to at least hourly
 Commence fluid balance monitoring, consider urinary catheter
 Midwife to inform Medical staff of at least Middle Grade(Registrar) level:
request to review as soon as possible andwithin 60 minutes
 Consider transfer to delivery suite
 Inform resident anaesthetist
 Check oxygen saturations and administer oxygen as appropriate
 Check for sepsis

Score 4-5  Refer to Qualified/Registered Professional to re-chec observations

 Minimum of hourly observations
 Commence fluid balance monitoring
 Medical staff of at least Middle Grade (Registrar) level to review within 30
minutes
 Registrar seeks senior advice
 Inform resident anaesthetist
 Transfer to delivery suite /inform delivery suite coordinator (ifwithin Women’s
Unit)
 Check oxygen saturations and administer oxygen as appropriate Check for sepsis
Score 6  Immediate transfer to delivery suite/inform delivery suite coordinator
or more  Request immediate review by most senior resident doctor (within 30
minutes)
 Senior resident doctor refers to Consultant Obstetrician and review within
an hour
 Inform resident anaesthetist
 Anaesthetist to inform Anaesthetic Consultant
 Contact Deteriorating Adult Response Team (DART) /consider direct contact
with ITU
 Observations documented at least every 15 minutes
 Check oxygen saturations and administer oxygen as appropriate
 Commence HDU chart where score >6
 Check for sepsis

Score = 4 in Please contact the delivery suite coordinator to plan

Women care and contact Obstetric and Anaesthetic SpR on call
admitted
outside
Maternity
8 PARAMETER MEOWS

1. Respiratory rate
2. Oxygen supplementation
3. Oxygen saturation
4. Heart rate
5. Systolic blood pressure
6. Siastolic blood pressure
7. Temperature
8. level of consciousness.
CARA PENGUKURAN MEOWS

 Respirasi
RESPIRASI

 SETELAH DILALUKAN PEMERIKSAAN RESPIRASI TULIS ANGKA YANG DIDPT

PADA KOLOM YG SESUAI
 MISALKAN 22 X/MNT TULIS DIKOLOM 21-25
TEMPERATURE
TEMPERATURE

 SETELAH DILALUKAN PEMERIKSAAN SUHUTULIS ANGKA YANG DIDPT PADA

KOLOM YG SESUAI
 MISALKAN 37,8 TULIS DIKOLOM 37 -37,9
HEART RATE
HEART RATE

 SETELAH DILALUKAN PEMERIKSAAN NADI TULIS ANGKA YANG DIDPT PADA

KOLOM YG SESUAI
 MISALKAN 120 TULIS DIKOLOM 120 -129
TEKANAN DARAH
 SETELAH DILALUKAN PEMERIKSAAN TEKANAN DARAH TULIS ANGKA YANG
DIDPT PADA KOLOM YG SESUAI
 MISALKAN 157/99 mmHgTULIS DIKOLOM YG SESUAI
 SYSTOLIC DITULIS DIKOLOM

 DIASTOLIS
DIASTOLIC BLOOD PRESSURE
NEURO RESPONSE
TINGKAT KESADARAN

 SETELAH DILALUKAN PEMERIKSAAN TINGKAT KESADARAN TULIS ANGKA

YANG DIDPT PADA KOLOM YG SESUAI
 MISALKAN COMPOSMENTIS TULIS DIKOLOM YG SESUAI
PAIN SCORE, SATURATION,MOTOR
BLOCK
PAIN SCORE, SATURATION,MOTOR
BLOCK
 SETELAH DILALUKAN PEMERIKSAAN PAIN SCORE, SATURATION,MOTOR
BLOCK TULIS ANGKA YANG DIDPT PADA KOLOM YG SESUAI
 MISALKAN
 PAIN SCORE : 3

 SATURATION /Sp02 : 98%

 MOTOR BLOCK : 0
LAIN - LAIN
PROTEINURI, LIQUOR, LOCHIA, SIGN OF
INFECTION
 SETELAH DILALUKAN PEMERIKSAAN PROTEINURI, LIQUOR, LOCHIA, SIGN
OF INFECTION TULIS ANGKA YANG DIDPT PADA KOLOM YG SESUAI
 MISALKAN
 PROTEINURI

 LIQUOR

 LOCHIA

 SIGN OF INFECTION
THANK YOU