Obstetric triage involves the systematic assessment, prioritization, and management of pregnant women presenting to healthcare facilities with obstetric emergencies or urgent medical conditions.

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The general principles of obstetric triaging include rapid evaluation, timely intervention, and appropriate disposition to ensure optimal maternal and fetal outcomes. When managing a mother presenting with features of maternal collapse, prompt recognition, resuscitation, and multidisciplinary collaboration are essential. Here’s how you can approach obstetric triage and management of maternal collapse:

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General Principles of Obstetric Triage:

Rapid Assessment:

Conduct a focused initial assessment of the mother’s clinical status, including vital signs, airway, breathing, circulation, mental status, and obstetric history, to identify potential life-threatening conditions or urgent medical concerns.

Triage Classification:

Assign a triage acuity level based on the severity of the mother’s condition, prioritizing immediate life-saving interventions for critically ill or unstable patients while ensuring timely evaluation and treatment for less urgent cases.

Multidisciplinary Collaboration:

Collaborate with obstetricians, midwives, nurses, anesthesiologists, neonatologists, and other healthcare providers to facilitate coordinated care, communication, and decision-making in obstetric emergencies.

Resource Allocation:

Allocate resources and personnel based on the clinical acuity and complexity of patients, ensuring the availability of essential equipment, medications, and trained staff to manage obstetric emergencies effectively.

Documentation and Communication:

Document triage assessments, interventions, and clinical findings accurately in the patient’s medical record, and communicate relevant information to the healthcare team, including handover reports, transfer summaries, and escalation protocols.

Management of Maternal Collapse:

Immediate Response:

Activate a rapid response or code team to provide immediate assistance and mobilize resources for maternal resuscitation, including advanced cardiac life support (ACLS) protocols and emergency obstetric interventions.

ABCDE Approach:

Follow the ABCDE approach (Airway, Breathing, Circulation, Disability, Exposure) to prioritize assessment and intervention for maternal collapse, addressing airway patency, oxygenation, hemodynamic stability, neurological status, and temperature regulation.

Airway Management:

Establish and maintain a patent airway using basic airway maneuvers (e.g., head tilt-chin lift, jaw thrust) or advanced airway techniques (e.g., endotracheal intubation, supraglottic airway devices) as needed to ensure adequate oxygenation and ventilation.

Breathing Support:

Provide supplemental oxygen therapy, assisted ventilation, or positive pressure ventilation (e.g., bag-valve-mask ventilation) to support respiratory function and improve oxygen delivery to vital organs.

Circulatory Support:

Initiate prompt cardiopulmonary resuscitation (CPR) with chest compressions and defibrillation as indicated for maternal cardiac arrest or severe hemodynamic instability, ensuring adequate perfusion and tissue oxygenation.

Hemorrhage Control:

Assess for signs of obstetric hemorrhage and initiate immediate measures to control bleeding, including uterine massage, administration of uterotonic medications (e.g., oxytocin, misoprostol), and expedited surgical interventions (e.g., uterine artery embolization, hysterectomy) as necessary.

Fluid Resuscitation:

Administer intravenous fluids, blood products, and hemodynamic support medications (e.g., vasopressors, inotropes) to optimize intravascular volume, blood pressure, and tissue perfusion in cases of hypovolemic shock or distributive shock.

Maternal Monitoring:

Continuously monitor maternal vital signs, electrocardiographic (ECG) rhythm, oxygen saturation, urine output, and laboratory parameters (e.g., hemoglobin, lactate) to assess response to treatment, guide ongoing management, and detect potential complications.

Fetal Assessment:

Perform fetal heart rate monitoring and obstetric ultrasound to assess fetal well-being, monitor for signs of fetal distress or compromise, and guide decisions regarding perinatal management and delivery timing.

Escalation of Care:
- Consider early consultation and transfer to a higher level of care, such as a tertiary care center with specialized obstetric and critical care services, for advanced management of maternal collapse, multidisciplinary interventions, and neonatal support.
Post-resuscitation Care:
- Provide post-resuscitation care, including ongoing hemodynamic stabilization, monitoring for complications (e.g., acute respiratory distress syndrome, disseminated intravascular coagulation), and intensive care support as needed to optimize maternal recovery and prevent recurrence of maternal collapse.

By adhering to the principles of obstetric triage and implementing a systematic approach to the management of maternal collapse, healthcare providers can effectively recognize, resuscitate, and manage obstetric emergencies, reduce maternal morbidity and mortality, and improve maternal and fetal outcomes in critically ill pregnant women. Early recognition, prompt intervention, and coordinated teamwork are essential components of successful obstetric emergency management and maternal resuscitation efforts.