Importance of Triaging Pregnant Women for Better Maternal Outcomes
TRIAGING PREGNANT WOMEN
2
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
Learning Objectives
•
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
Triaging
3
4
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
Triaging Pregnant Women
Obstetric History and examination
Risk assessment
Review resources
Review resources
5
•
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
Key Messages
Efficient triaging of pregnant women plays a crucial role in addressing delays in seeking care, transportation, and initiating appropriate care at the facility. By categorizing women based on their needs, healthcare providers can ensure timely and appropriate interventions, such as normal delivery, caesarean section, or referral to higher centers. Key messages emphasize the significance of thorough assessment, correct gestational age estimation, proper technique in examinations, and the importance of various measurements for maternal well-being.
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Presentation Transcript
Learning Objectives By the end of this session, learners will be able to: Explain triaging based on history taking and initial clinical examination into different categories Demonstrate the correct technique for abdominal examination of woman in labor on appropriate models using skills checklists Demonstrate hand washing technique, wearing and removal of gloves, pelvic examination Describe the importance and technique of BP measurement, hemoglobin estimation by Sahli s method, urine protein and sugar estimation using Uristix 2
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 3
Triaging Pregnant Women Pregnant woman Obstetric History and examination Needs caesarean Section Normal delivery can be done Risk assessment Review resources No identifiable risk of complication: Nurse led intervention Risk of complication: specialist led intervention Caesarean facility available Caesarean facility not available Review resources Specialist care available Specialist care not available Conduct normal delivery Refer client to higher center Conduct caesarean section 4
Key Messages Triaging is important to prevent the delay for referral based on history taking, examination and decision making for the level of care SCC is important in assessing the clients for referral. Correct gestational age can be estimated by fundal height measurement, LMP and USG PV examination should be done after hand washing and wearing gloves on both hands BP checkup cuff should be tied above cubital fossa at the level of heart For Hb estimation reading in tube should be done at lower meniscus level For urine protein match colour immediately after dipping in clean urine sample and for sugar match colour after 30 seconds 5
