July 2003 · Vol. 15, No. 7Avoiding the pitfalls of obstetric triage
This process has streamlined the evaluation of labor and common complaints of pregnancy, such as diminished fetal movements and vaginal discharge. Here, a look at optimal screening, with case presentations illustrating the physician’s key role.
GARY
VENTOLINI,
MD;
RAN
NEIGER,
MDDr. Ventolini is associate professor of obstetrics and gynecology and Dr. Neiger is clinical professor, division of maternal-fetal medicine, Wright State University,
Dayton, Ohio.
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KEY POINTS
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Several studies have documented the cost-effectiveness of obstetric triage, as well as patient satisfaction with the arrangement.
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Any number of medical errors are possible during triage, the most common being incorrect assessment of the mother or fetus and incorrect diagnosis of true labor.
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The most common task required of obstetric triage personnel is labor evaluation.
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Several maternal symptoms require special evaluation. These include abdominal trauma, vaginal bleeding, motor vehicle accidents, decreased fetal movements, abdominal pain, and leakage of fluid.
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Although nonphysician personnel provide the majority of obstetric triage services, close supervision by a doctor is required because of the considerable risks involved.1 Careful attention also is recommended because responsibility for the patient’s well-being—and that of her infant—ultimately lies with her obstetrician, even if another practitioner conducts the initial assessment. (See the example Case 1 and Case 2.
Thus, it is in the physician’s best interest to ensure that women who present to the triage unit are properly evaluated. This entails checking maternal vital signs and ascertaining the chief complaint, taking a complete history, and gauging risk based on the patient’s prenatal records. Assessment of fetal well-being includes evaluating fetal movements, performing a nonstress test, and calculating the appropriate amniotic fluid index or biophysical profile for the gestational age.
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