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Midwife-performed checklist and ultrasound to identify obstetric conditions at labour triage in Uganda: A quasi-experimental study

  • Mulowooza, Jude1
  • Santos, Nicole2
  • Isabirye, Nathan1
  • Inhensiko, Innocent1
  • Sloan, Nancy L.2
  • Shah, Sachita3
  • Butrick, Elizabeth2
  • Waiswa, Peter1, 4
  • Walker, Dilys2, 5
  • 1 Makerere University, School of Public Health, P.O Box 7072, Kampala, Uganda
  • 2 Institute for Global Health Sciences, University of California San Francisco, 550 16th Street, 3rd floor, San Francisco, CA 94158 United States
  • 3 Department of Emergency Medicine, University of Washington, 325 9th Ave., Seattle, WA 98104 United States
  • 4 Global Health Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
  • 5 Department of Obstetrics, Gynaecology and Reproductive Sciences, University of California San Francisco, United States
Published Article
Churchill Livingstone
Publication Date
May 01, 2021
DOI: 10.1016/j.midw.2021.102949
PMID: 33631411
PMCID: PMC7988503
PubMed Central
  • Article


Objective The aim of this study was to evaluate the effect of a midwife-performed checklist and limited obstetric ultrasound on sensitivity and positive predictive value for a composite outcome comprising multiple gestation, placenta praevia, oligohydramnios, preterm birth, malpresentation, abnormal foetal heart rate. Design Quasi-experimental pre-post intervention study. Setting Maternity unit at a district hospital in Eastern Uganda. Interventions Interventions were implemented in a phased approach: standardised labour triage documentation (Phase 1), a triage checklist (Phase 2), and checklist plus limited obstetric ultrasound (Phase 3). Participants Consenting women presenting to labour triage for admission after 28 weeks of gestation between February 2018 and June 2019 were eligible. Women not in labour or those requiring immediate care were excluded. 3,865 women and 3,937 newborns with similar sample sizes per phase were included in the analysis. Measurement and findings Outcome data after birth were used to determine true presence of a complication, while intake and checklist data were used to inform diagnosis before birth. Compared to Phase 1, Phase 2 and 3 interventions improved sensitivity (Phase 1: 47%, Phase 2: 68.8%, Phase 3: 73.5%; p  ≤ 0.001) and reduced positive predictive value (65.9%, 55%, 48.7%, p  ≤ 0.001) for the composite outcome. No phase differences in adverse maternal or foetal outcomes were observed. Conclusion Both a triage checklist and a checklist plus limited obstetric ultrasound improved accurate identification of cases with some increase in false positive diagnosis. These interventions may be beneficial in a resource-limited maternity triage setting to improve midwives' diagnoses and clinical decision-making.

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