Manfaat Maternal Early Obstetric Warning Score (Meows) Dalam Memprediksi Lama Perawatan Pada Pasien Preeklamsia Berat Di RSUP Dr. Sardjito

SULISTIANTO, dr. Rukmono Siswishanto, M.Kes, Sp.OG(K)-KFM, MP.; dr. Ahsanudin Attamimi, Sp.OG(K)-KFM, M.Med. Ed

2022 | Tesis-Spesialis | OBSTETRI DAN GINEKOLOGI

Latar Belakang: skor MEOW sangat penting untuk menilai kondisi klinis pasien dengan adanya perubahan tanda vital selama pasien dirawat. Adanya perubahan ini akan berpengaruh terhadap lama perawatan pasien preeklamsia berat. Lama perawatan merupakan indikator penting dari efisiensi manajemen rumah sakit. Pengurangan jumlah lama perawatan dapat menurunkan risiko infeksi, meningkatkan kualitas pengobatan dan meningkatkan keuntungan rumah sakit dengan manajemen tempat tidur yang lebih efisien. Namun saat ini belum ada penelitian mengenai hubungan skor MEOW dengan lama perawatan pasien preeklamsia berat yang dirawat di rumah sakit. Tujuan: Mengetahui apakah skor MEOW berhubungan dengan lama perawatan pasien preeklamsia berat. Metode: Desain penelitian ini adalah kohort retrospektif. Subjek penelitian adalahpasien hamil dengan diagnosis preeklamsia berat sesuai dengan kriteria inklusi dan kriteria eksklusi di RSUP Dr. Sardjito sejak Juli 2020 sampai dengan Juni 2021. Data diambil dari rekam medis kemudian dihitung lama rawatnya dan dianalisis tentang hubungan skor MEOW dengan lama perawatan pasien preeklamsia berat. Hasil: Dari 86 subjek penelitian didapatkan 78 sampel yang memenuhi kriteria inklusi dan eksklusi. Berdasarkan karakteristik subjek penelitian didapatkan paritas primigravida (69,2%), obesitas (51,3%) dan riwayat hipertensi (53,8%). Hal ini sesuai referensi bahwa faktor resiko preeklamsia berat yaitu primigravida, obesitas dan riwayat hipertensi. Hasil dari ROC yaitu nilai AUC 0,878 dengan p = 0,001 dan CI 95% (0,745 - 1). Penentuan nilai cut off point skor MEOW yaitu 8,5 atau 9 dengan sensitivitas 92%, spesifisitas 71% dan Youden Index tertinggi = 0,631. Lama perawatan antara pasien dengan skor MEOW >=9 dan pasien dengan skor MEOW <9 berbeda secara signifikan (p <0,05). Skor MEOW >=9 memiliki lama perawatan lebih lama dibandingkan skor MEOW <9. Tidak ada perbedaan bermakna antara variabel luar dan skor MEOW (p >0,05). Tidak ada perbedaan bermakna antara variabel luar dan lama perawatan (p >0,05). Kesimpulan: Pasien preeklamsia berat yang mengalami persalinan di RSUP dr. Sarjito dengan skor MEOW tinggi memiliki lama perawatan yang lebih lama dibandingkan dengan skor MEOW rendah.

Background: The MEOWS is very important to assess the clinical condition of the patient related to changes in vital signs during the patient hospitalized. These changes are also related to conditions during and after childbirth. These changes will affect the length of treatment for patients preeclampsia with severe features. Length of stay is an important indicator of the efficiency of hospital management. Reducing the number of hospital stays can reduce the risk of infection, improve thequality of treatment and increase hospital profits with more efficient bed management. However, currently there is no study on the relationship between MEOWS and length of stay in patients preeclampsia with severe features. Objective: aimed to find out the relationship between MEOWS and length of stay in preeclampsia with severe features patients Methods: The study design was a retrospective cohort. The research subjects were pregnant patients diagnosed preeclampsia with severe features according to inclusion and exclusion criteria at Dr. Sardjito Hospital from July 2020 to June 2021. The data were taken from medical records then analyzed about the relationship between MEOWS and length of stay of preeclampsia with severe features patients. Results: From 86 research subjects, 78 samples met the inclusion and exclusion criteria. Based on the characteristics of the research subjects, it was found that primigravida (69.2%), obesity (51.3%) and history of hypertension (53.8%). This is in accordance with the reference that the risk factors for preeclampsia with severe feature are primigravida, obesity and a history of hypertension. The result of the ROC is the AUC value of 0.878 with p = 0.001 and 95% CI (0.745 - 1). Determination of the cut off point value of the MEOW score is 8.5 or 9 with a sensitivity of 92%, a specificity of 71% and Youden Index= 0.631. Length of stay between patients with MEOWS 9 and patients with MEOWS <9 was significantly different (p <0.05). MEOWS 9 had a longer length of stay than MEOW score <9. There was no significant difference between the external variables and the MEOW score (p >0.05). There was no significant difference between the external variables and the length of stay (p >0.05). Conclusion: Preeclampsia with severe features patiens who gave birth at Dr. Sardjito Hospital with high MEOWS have a longer length of stay than those with a low MEOWS.

Kata Kunci : MEOWS, preeklamsia berat, lama perawatan, preeclampsia with severe features, length of stay.