Obstetric Triaging.pptx

Obstetric Triage concepts and table used in Labour ward triaging

1. Obstetric Triaging Dr R.Divya MS (OG) PG

2. Learning Objectives B y t he end o f t h i s s e ss i on, l ea r n e r s w il l be ab l e t o : E x p l a i n tr i a g i ng based o n h i s t o r y t a k i ng and i n i t i al c li n i cal e x a m i na t i on into different categories D e m ons t r a t e t he co r r e c t t echn i q ue f o r abdo m i nal examination of woman in labor on app r o p r i a t e m odels us i ng s k ills che c k li s t s D e m ons t r a t e hand washing technique, w ea r i ng a n d r e m o v al o f g l o v es, pe l v i c e x a m i na t i on D escribe the importance and technique of B P m easu r e m ent, hemo g l ob i n es t i m a t i on by S ah li’ s m e t hod, u r i ne p r o t e i n and sugar es t i m a t i on us i n g U r i s t i x

3. Triage tools have been shown to increase efficiency and accuracy of obstetric triage Triage guides have improved quality and efficiency of care in emergency departments, providing a standardised structure S everal key issues could be resolved through development and implementation of a triage guide

4.   Basics of Triage Proceed with high level of suspicion Sick or not sick Appropriate location to evaluate patient Term vs PretermVitals Medical comorbidities Pregnancy complications Capabilities of facility

5. Checklist in Triage Labor check Term vs Preterm Membrane rupture check Decreased fetal movement Vaginitis Urinary tract complaints

6. Common Obstetrical Emergencies:  HTN Chronic HTN HTN prior to 20 weeks gestation Gestational HTN HTN after 20 weeks gestation PreeclampsiaWith /without severe features BP 140/90, +/- proteinuria, low plt , high LFT, renal failure, cerebral disturbances, etc Chronic HTN with superimposed preeclampsia EclampsiaPreeclampsia + seizure

7. Triaging Three delays resulting in poor maternal outcomes are: Delay in decision to seek care Delay in transportation Delay in initiating appropriate care at the facility Triaging is important to address third delay at the facility Triaging is classification of clients after initial assessment into categories based on action required Application into Labour process: Conduct initial assessment of the client based on obstetric history and obstetric examination Designate into categories according to need Review facility’s ability to provide need based care Designate into categories based on action

8. Triaging Pregnant Women 8 Pregnant woman Normal delivery can be done No identifiable risk of complication: Nurse led intervention Conduct normal delivery Risk of complication: specialist led intervention Specialist care available Specialist care not available Needs caesarean Section Caesarean facility not available Refer client to higher center Caesarean facility available Conduct caesarean section Obstetric History and examination Risk assessment Review resources Review resources

9. Obstetric Triage Tool

10. Key Messages T r i a g i n g i s i m p o rt a n t t o p r e v ent t he de l ay f or r e f e r r al based on h i s t o r y t a k i n g, e x a m i na t i on and dec i s i on m a k i n g f o r t he l e v el o f ca r e SC C i s i m po rt a n t i n as s ess i ng t he c li en t s f or r e f e rr a l . C o rr ect g e s t a t i onal a g e c an be e s t i m a t ed by f un d al he i g ht m easu r e m en t , L M P and US G P V e x a m i na t i on shou l d b e done a ft e r hand w ash i ng and w ea r i ng g l o v es on bo t h hands B P che c k up c u f f shou l d be t i ed abo v e cub i t al f o s sa at t he l e v el of hea r t For H b e s t i m a t i on r ead i ng i n t ube shou l d be done at l o w er m en i scus l e v el For u r i ne p r o t e i n m a t ch co l our i mm ed i a t e l y a f t e r d i pp i ng i n c l ean u r i ne sa m p l e and f or su g a r m a t ch co l our a ft e r 30 seconds

11. Thank You