Effect of a labor triage checklist and ultrasound on obstetric referral at three primary health centers in Eastern Uganda

Objective To test whether introduction of a midwife‐performed triage checklist and focused ultrasound improves diagnosis and referral for obstetric conditions, including multiple gestation, placenta previa, oligohydramnios, preterm birth, malpresentation, and abnormal fetal heart rate. Methods We im...

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Bibliographic Details
Published in:International journal of gynecology and obstetrics 2021-04, Vol.153 (1), p.130-137
Main Authors: Santos, Nicole, Mulowooza, Jude, Isabirye, Nathan, Inhensiko, Innocent, Sloan, Nancy L., Shah, Sachita, Butrick, Elizabeth, Waiswa, Peter, Walker, Dilys
Format: Article
Language:English
Subjects:
Adolescent
Adult
Checklist
Clinical
Female
Humans
Infant, Newborn
Labor, Obstetric
Maternity triage
Midwifery
Predictive Value of Tests
Pregnancy
Premature Birth - diagnosis
Primary health center
Referral
Referral and Consultation
Triage
Uganda
Ultrasonography, Prenatal
Ultrasound
Young Adult
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Summary:Objective To test whether introduction of a midwife‐performed triage checklist and focused ultrasound improves diagnosis and referral for obstetric conditions, including multiple gestation, placenta previa, oligohydramnios, preterm birth, malpresentation, and abnormal fetal heart rate. Methods We implemented an intake log (Phase 1), a checklist (Phase 2), and a checklist plus ultrasound scan (Phase 3) at three primary health centers in Eastern Uganda for women presenting in labor. Intake diagnoses, referral status, and delivery outcomes were assessed, as well as sensitivity and positive predictive value (PPV). Results Between February 2018 and July 2019, 1155, 961, and 603 women were enrolled across the three phases (n=2719); 2339 had outcome data. Incidence of any outcome‐confirmed condition was 8.8%, 7.9%, and 7.1% (P=0.526) for each phase, respectively. The proportion of referred women with a condition did not change between Phases 1 and 2 (7.8% versus 8.6%, P=0.855), but increased in Phase 3 (48.4%, P
ISSN:0020-7292
1879-3479
DOI:10.1002/ijgo.13420