Rapid initial assessment

When a woman of childbearing age presents with a problem, rapidly assess her condition to determine her degree of illness.

 Table C 1 Rapid initial assessment ^a

^a This list does not include all the possible problems that a woman may face in a pregnancy or the puerperal period. It is meant to identify those problems that put the woman at greater risk of maternal morbidity and mortality.

The woman also needs prompt attention if she has any of the following signs: 

• blood-stained mucus discharge (show) with palpable contractions;
• ruptured membranes;
• pallor;
• weakness;
• fainting;
• severe headaches;
• blurred vision;
• vomiting;
• fever;
• respiratory distress.

The woman should be sent to the front of the queue and promptly treated.

IMPLEMENTING A RAPID INITIAL ASSESSMENT SCHEME

Rapid initiation of treatment requires immediate recognition of the specific problem and quick action. This can be done by:

• training all staff—including clerks, guards, door-keepers or switchboard operators—to react in an agreed upon fashion (“sound the alarm”, call for help) when a woman arrives at the facility with an obstetric emergency or pregnancy complication or when the facility is notified that a woman is being referred;
• clinical or emergency drills with staff to ensure their readiness at all levels;
• ensuring that access is not blocked (keys are available) and equipment is in working order (daily checks) and staff are properly trained to use it; 
• having norms and protocols (and knowing how to use them) to recognize a genuine emergency and know how to react immediately;
• clearly identifying which women in the waiting room—even those waiting for routine consultations—warrant prompt or immediate attention from the health worker and should therefore pass to the front of the queue (agreeing that women in labour or pregnant women who have any of the problems noted in Table C-1 should immediately be seen by a health worker);• agreeing on schemes by which women with emergencies can be exempted from payment, at least temporarily (local insurance schemes, healthcommittee emergency funds).

Top of page