Triage Quick Reference Guide

Obstetrics

Page last updated: 21 January 2013

The following table provides the urgency indicators for obstetrics.

Urgency	Urgency Indicator	Reason for Caution
Airway	Any potential compromise Increased nasal congestion	Often difficult intubations due to: - increased patient size - difficulty with patient positioning - different induction agents required Increased vascularity of nose and airways causes difficulty in breathing
Breathing	Asthma	Progesterone may be responsible for increased drive to breathe One third of pregnant asthmatic women experience a deterioration in their condition
Circulation	Palpitations Headache Sudden drop in BP Symptoms of pulmonary embolus	Progesterone causes widespread vasodilatation Oestrogen may contibute to increases in blood volume Diastolic BP - 6-17mmHg BP lowest during second trimester Cardiac output (CO) - by 30-50% Haemodynamic flow High volume and dynamic flow may cause cerebral haemorrhage, especially subarachnoid haemorrhage (SAH) during pregnancy Sudden and serious deterioration of their condition Changes in coagulation system associated with pregnancy

Hyperdynamic physiological changes occur as early as 6-8 weeks gestation.
An assessment of urgency must be made on the basis of both the woman and the foetus.
An elevated BP is an ominous sign: the higher the BP the more urgent the review.
At 20 weeks the weight of the uterus compresses the inferior vena cava if the woman is lying on her back - a compromise to foetal wellbeing.
The risk of many conditions is higher in pregnant women than non-pregnant women of child bearing age. These conditions include:
- cerebral haemorrhage or cerebral thrombosis
- severe pneumonia
- atrial arrythmias
- venous thrombosis
- cholelithiasis
- pyelonephritis
- spontaneous arterial dissections, e.g. splenic and subclavian dissections, with no previous medical history.
Domestic violence is more prevalent during pregnancy. This can mean increased complications for mother and adverse neonatal outcomes.
In the setting of trauma, maternal signs may remain stable even when the loss of one-third of blood volume may have occured.
The best initial treatment for the foetus is the optimum resuscitation of the mother.