Contoh Critical Appraisal

1. www.ugm.ac.id Locally Rooted, Globally Respected
Critical Appraisal
Hypertension in Pregnancy
Inggong
Adelina
Silvia

2. www.ugm.ac.id Locally Rooted, Globally Respected
Clinical Scenario
● Pasien hamil usia 35 tahun G2P1A0 hamil 30 minggu datang ke tempat praktek Dokter
Layanan Primer untuk ANC.
● TD 160/ 110 mmHg , Nadi 98 x / menit, RR 24 x/ menit
● Pasien mengaku merasa takut karena kakaknya meninggal akibat tekanan darah tinggi
pada waktu hamil sehingga pasien datang meminta obat tekanan darah agar tekanan
darahnya terkontrol.
--> Obat antihipertensi apakah yang aman di konsumsi oleh ibu hamil tersebut?

3. www.ugm.ac.id Locally Rooted, Globally Respected
PICO
P : Patient with hypertension in
pregnancy
I : Nifedipine
C : Labetalol, Metildopa
O : decrease blood presure

4. www.ugm.ac.id Locally Rooted, Globally Respected
Search Strategy

5. www.ugm.ac.id Locally Rooted, Globally Respected
1a. Was the assignment of patients to treatments randomised?
● YES

6. www.ugm.ac.id Locally Rooted, Globally Respected
1b. Were the groups similar at the start of the trial?
● YES

7. www.ugm.ac.id Locally Rooted, Globally Respected

8. www.ugm.ac.id Locally Rooted, Globally Respected
2a. Aside from the allocated treatment, were groups
treated equally ?
● YES

9. www.ugm.ac.id Locally Rooted, Globally Respected
2b. Were all patient who entered the trial accounted for?
And were they analysed in the groups to which they
were randomised?
● Partisipan yang drop off < 20%
●  pada penelitian ini : lose to follow up 14 %
● Di follow up dalam 6 jam tiap 20 menit
● YES

10. www.ugm.ac.id Locally Rooted, Globally Respected
3. Were measures objective or were the patients and
clinicians kept “blind” to which treatment was being
received?
● NO.

11. www.ugm.ac.id Locally Rooted, Globally Respected
How large was the treatment effect?
How precise was the estimate of the treatment effect?
 Confident interval 95% and p value <
0,05

12. www.ugm.ac.id Locally Rooted, Globally Respected
Conclusion
● Penelitian ini valid, penting dan dapat diaplikasikan di setting perawatan primer
dengan low resources.

13. www.ugm.ac.id Locally Rooted, Globally Respected
Lesson learned
1. Di layanan primer,ada 3 pilihan obat hipertensi sebagai pilihan awal
dalam terapi hipertensi gestasional yaitu Nifedipine,Labetalol dan
Metildopa.
2. Obat pilihan utama Hipertensi Gestasional adalah Nifedipine
(ACOG,2013 ). Literatur lain menyebutkan Nifedipine digunakan sebagai
terapi pre eklampsia dengan tekanan darah sistolik >160mmHg dan
distolik >110mmHg ( POGI,2016 )
3. Mekanisme kerja dari nifedipine adalah dengan menurunkan masuknya
ion kalsium ke dalam sel otot jantung dan otot pembuluh darah. Efek ini
akan menurunkan kemampuan jantung untuk berkontraksi serta memicu
vasodilatasi.
4. Dosis nifedipine yang disarankan 3x10mg