Rapid Initial Assessment

1
Rapid Initial Assessment

• Managing Complications in Pregnancy and Childbirth

2
Session Objectives

• To discuss best practices for the initial
  assessment of obstetrical patients
• To review implementation of a rapid assessment
  scheme

3
Definition

• A quick check of a womans condition when she
  presents with a problem to rapidly determine her
  degree of illness

4
Assess Condition

• Airway and breathing
• Circulation (signs of shock)
• Vaginal bleeding (early or late pregnancy or
  after childbirth)
• Unconscious or convulsing
• Dangerous fever
• Abdominal pain

5
Assess Airway and Breathing

• Danger signs
• Look for
• Cyanosis
• Respiratory distress
• Examine
• Skin Pallor
• Lungs Wheezing or rales
• Consider
• Severe anemia
• Heart failure
• Pneumonia
• Asthma

6
Assess Circulation

• Examine
• Skin Cool and moist
• Pulse Fast (110 beats/min. or more) and weak
• Blood pressure Low (systolic less than 90 mm Hg)
• Consider shock even if blood pressure is normal

7
Assess Vaginal Bleeding

• Ask if
• Pregnant and length of gestation
• Recently given birth
• Placenta delivered
• Examine
• Vulva Amount of bleeding, placenta retained,
  obvious tears
• Uterine fundus Atony
• Bladder Full
• DO NOT DO VAGINAL EXAMINATION AT THIS STAGE

8
Assess Vaginal Bleeding (contd)

• Consider

9
Assess Unconsciousness or Convulsions

• Danger signs
• Ask if pregnant and length of gestation
• Examine
• Blood pressure Diastolic 90 mm Hg or more
• Temperature 38ºC or more
• Consider
• Eclampsia
• Malaria
• Epilepsy
• Tetanus

10
Assess Dangerous Fever

• Danger signs
• Ask if
• Weak, lethargic
• Frequent, painful urination
• Examine
• Temperature 38ºC or more
• Unconscious
• Neck Stiffness
• Lungs Shallow breathing, consolidation
• Abdomen Severe tenderness
• Vulva Purulent discharge
• Breasts Tenderness

11
Assess Dangerous Fever (contd)

• Consider
• Urinary tract infection
• Malaria
• Metritis
• Pelvic abscess
• Peritonitis
• Breast infection
• Complications of abortion
• Pneumonia

12
Assess Abdominal Pain

• Danger signs
• Ask if pregnant and length of gestation
• Examine
• Temperature 38ºC or more
• Pulse 110 beats/min. or more
• Blood pressure Systolic less than 90 mm Hg
• Uterus State of pregnancy

13
Assess Abdominal Pain (contd)
Consider

• Obstetrical Causes
• Ectopic pregnancy
• Possible term or preterm labor
• Amnionitis
• Abruptio placentae
• Ruptured uterus

• Nonobstetrical Causes
• Ovarian cyst
• Appendicitis

14
Signs and Symptoms That Require Prompt Treatment

• Blood-stained mucus discharge with palpable
  contractions
• Ruptured membranes
• Pallor
• Weakness
• Fainting
• Severe headaches
• Blurred vision
• Vomiting
• Fever
• Respiratory distress

15
Implementing a Rapid Initial Assessment Scheme

• Train ALL staff to react in agreed-upon fashion
  when woman arrives at facility with obstetric
  emergency or pregnancy complication
• Practice clinical drills or emergency drills with
  staff to ensure readiness at all levels
• Ensure that access is not blocked, equipment is
  in working order and staff is properly trained to
  use equipment

16
Implementing a Rapid Initial Assessment Scheme
(contd)

• Develop norms and protocols to distinguish a real
  emergency and how to react immediately
• Clearly identify women in waiting room who need
  prompt or immediate attention
• Agree on schemes by which women with emergencies
  can be exempted from payment, at least
  temporarily