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Effect of a labor triage checklist and ultrasound on obstetric referral at three primary health centers in Eastern Uganda
Author(s) -
Santos Nicole,
Mulowooza Jude,
Isabirye Nathan,
Inhensiko Innocent,
Sloan Nancy L.,
Shah Sachita,
Butrick Elizabeth,
Waiswa Peter,
Walker Dilys
Publication year - 2021
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1002/ijgo.13420
Subject(s) - medicine , referral , checklist , triage , obstetrics , psychological intervention , incidence (geometry) , emergency medicine , family medicine , nursing , psychology , physics , optics , cognitive psychology
Abstract 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 <0.001). Sensitivity improved with each intervention; PPV decreased with ultrasound. Conclusion Use of ultrasound plus checklist increased referrals and sensitivity for high‐risk conditions, with decreased PPV. The checklist alone improved correct diagnosis, but not referral. Further evaluation of these triage interventions to maximize diagnostic accuracy, referral decisions, and outcomes are warranted.