Maternal/Obstetric and

Pediatric EWS
Case Discussion

Revised by AB 1/11/2018
Modified Early Obstetric Warning system
• The MEOWS is calculated by scoring the values of a full set of
observations carried out routinely by staff which include;
Temperature
Systolic blood pressure
Diastolic blood pressure
Heart rate
Respiratory rate
Level of consciousness using AVPU scale
+/- urine output
MEOWS Action Plan
 White only :
• Continue observation as before
 Single Yellow :
• Inform the midwife/nurse in charge
• Recheck observation in 1 hour (or more frequently if clinically idicated)
 2 Yellow or 1 Red :
• Inform the midwife/nurse in charge
• Immediately contact the on call obstetric/Reg using a structural
communication
• Approach eg SBAR, to review the woman within 30 minutes
• Recheck observation in 30 minutes (or more frequently if clinically
idicated)
MEOWS Action Plan
 2 Red
• Inform the midwife/nurse in charge
• Immediately contact the on call obstetric/Reg using a structural communication
Approach eg SBAR, to review the woman within 20 minutes
• Recheck observation in 15 minutes (or more frequently if clinically idicated)
 > 2 Red :
• Inform the midwife/nurse in charge
• Immediately contact the on call obstetric/Reg using a structural communication
Approach eg SBAR, to review the woman within 20 minutes
• Discuss with Obstetric Consultant/Tutor
• Recheck observation in 15 minutes (or more frequently if clinically indicated)

• # consider calling other specialities or emergency obstetric team as appropriate

*Ranges adapted from NICE guidance on Hypertension in pregnancy (2010)
Temperature range adapted from MEWS obstetrics from Rosie Maternity Hospital, Cambridge
University Hospital NHS foundation trust
Pulse, Respiratory rate, AVPU, Urine output adapted from NNUH NHS Trust early warning score.
 Contoh Kasus 1
• Wanita, 36 th Hamil aterm
• Kesadaran : CM
• Tekanan darah : 180/110 mmHg
• Nadi : 102 x/mnt
• Suhu : 38.0 C
• Pernapasan : 22x /mnt
• Sat O2 : 100%
• Oksigen nasal 3 lpm
• Berapa nilai “EWS” pada pasien
ini?
O/MEWS Score
Implementasi
Keterangan
• Penggunaan sistem scoring sebagai universal
data u menentukan status dan level
monitoring.
• Membantu dalam penanganan pasien secara
multidisiplin.
• Mengajak keluarga pasien sebagai team
dalam memahami penanganan medis.
 Contoh Kasus 2
• Wanita, 30 tahun Post SC
• Kesadaran : apatis
• Tekanan darah : 100/53 mmHg
• Nadi : 62 x/mnt
• Suhu : 35.5 C
• Pernapasan : 10x /mnt
• Sat O2 : 95%
• Oksigen nasal 3 lpm
• Berapa nilai “EWS” pada pasien
ini?
O/MEWS Score
Implementasi
Keterangan
• Level kesadaran merupakan kompensasi
paling akhir dalam “score”.
• Menunjukkan ada proses lain yg menjadi
masalah.
• Dapat menyebabkan masalah jalan nafas yg
serius.
• Dibutuhkan penilaian yg baik dalam menilai
kesadaan.
• Apakah intubasi di perlukan?
Pediatric Early Warning System

Core PEWS parameter Additional parameter

• Concern
• Respiratory rate
• Respiratory effort
• Oxygen therapy
• Heart rate
• Conscious level
• Oxygen saturations
• Central capillary refill time.
• Blood pressure (systolic)
• Skin colour
• Temperature

20
Age-specific National Charts
 Contoh Kasus 1
• Anak laki laki, 9 tahun 25 kg
• Rencana operasi open biopsi
tumor abdomen esok hari
• KU : Baik
• Kesadaran : CM kooperatif
• Nadi : 134 x/mnt
• Suhu : 39,2 C
• Pernapasan : 32 x/mnt
• “Room Air” Sat 97%
• Berapa nilai “EWS” pada pasien
ini?
PEWS Score
Implementasi

KIE keluarga dalam mengambil

keputusan dan prognosis pasien
Keterangan
• Menjaga kesinambungan pemantauan
keadaan pasien.
• Mencegah keterlambatan penentuan
keadaan umum pasien (unplanned admissions
ICU patiens) dan intervensi yang diperlukan
• Memberikan kesempatan keluarga pasien
berdiskusi dalam menggambil keputusan
 Contoh Kasus 2
• Anak perempuan, 1 tahun 3 bulan 10 kg
CKD
• Kesadaran : Somnolen Gelisah
• Tekanan darah : 149/77 mmHg
• Nadi : 140 x/mnt
• Suhu : 40 C
• Pernapasan : 38x /mnt
• Sat O2 : 84 %
• Oksigen NRM 8 lpm
• Berapa nilai “EWS” pada pasien ini?
PEWS Score
Implementasi

KIE keluarga dalam mengambil

keputusan dan prognosis pasien
Keterangan
• Dengan adanya “score” ini maka diharapkan
kesamaan dalam “bahasa” menggenai kondisi
pasien.
• Komunikasi yang baik akan meningkatkan
perawatan yang baik dan berkesinambungan.
• Pengenalan perubahan kondisi yang seawal
mungkin, memungkinkan intervensi yang awal.
Revised by AB 1/11/2018
Maternal Early Warning Criteria
• Systolic BP; mmHg <90 or >160
• Diastolic BP; mmHg >100
• Heart rate; bpm <50 or >120
• Respiratory rate; bpm <10 or >30
• Oxygen saturation; % <95
• Oliguria; mL/hr x 2h <35
• Maternal agitation, confusion, or unresponsiveness
• Patient with hypertension or preeclampsia reporting a non-
remitting headache or shortness of breath

Mhyre JM, Obstet Gynecol 2014; 124:782-6

Modified Early Obstetric Warning system
• Of all the variables the respiratory rate is the most sensitive
indicator.
• Physiological changes in pregnancy might include:
Increase in heart rate by 15-20 bpm
Respiratory rate increases by 2 breaths per minute
Blood pressure decreases by 10 mm Hg
IMEWS Frequency Table