{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T22:39:59Z","timestamp":1773009599974,"version":"3.50.1"},"reference-count":22,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2020,11,4]],"date-time":"2020-11-04T00:00:00Z","timestamp":1604448000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2020,11,4]],"date-time":"2020-11-04T00:00:00Z","timestamp":1604448000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp;amp; Obste"],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To test whether introduction of a midwife\u2010performed triage checklist and focused ultrasound improves diagnosis and referral for obstetric conditions, including multiple gestation, placenta previa, oligohydramnios, preterm birth, malpresentation, and abnormal fetal heart rate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We implemented an intake log (Phase 1), a checklist (Phase 2), and a checklist plus ultrasound scan (Phase 3) at three primary health centers in Eastern Uganda for women presenting in labor. Intake diagnoses, referral status, and delivery outcomes were assessed, as well as sensitivity and positive predictive value (PPV).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Between February 2018 and July 2019, 1155, 961, and 603 women were enrolled across the three phases (n=2719); 2339 had outcome data. Incidence of any outcome\u2010confirmed condition was 8.8%, 7.9%, and 7.1% (\n                      <jats:italic>P<\/jats:italic>\n                      =0.526) for each phase, respectively. The proportion of referred women with a condition did not change between Phases 1 and 2 (7.8% versus 8.6%,\n                      <jats:italic>P<\/jats:italic>\n                      =0.855), but increased in Phase 3 (48.4%,\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001). Sensitivity improved with each intervention; PPV decreased with ultrasound.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Use of ultrasound plus checklist increased referrals and sensitivity for high\u2010risk conditions, with decreased PPV. The checklist alone improved correct diagnosis, but not referral. Further evaluation of these triage interventions to maximize diagnostic accuracy, referral decisions, and outcomes are warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ijgo.13420","type":"journal-article","created":{"date-parts":[[2020,10,13]],"date-time":"2020-10-13T00:25:54Z","timestamp":1602548754000},"page":"130-137","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Effect of a labor triage checklist and ultrasound on obstetric referral at three primary health centers in Eastern Uganda"],"prefix":"10.1002","volume":"153","author":[{"given":"Nicole","family":"Santos","sequence":"first","affiliation":[{"name":"Institute for Global Health Sciences University of California San Francisco San Francisco CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jude","family":"Mulowooza","sequence":"additional","affiliation":[{"name":"School of Public Health Makerere University Kampala Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathan","family":"Isabirye","sequence":"additional","affiliation":[{"name":"School of Public Health Makerere University Kampala Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Innocent","family":"Inhensiko","sequence":"additional","affiliation":[{"name":"School of Public Health Makerere University Kampala Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nancy L.","family":"Sloan","sequence":"additional","affiliation":[{"name":"Institute for Global Health Sciences University of California San Francisco San Francisco CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sachita","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Washington Seattle WA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Butrick","sequence":"additional","affiliation":[{"name":"Institute for Global Health Sciences University of California San Francisco San Francisco CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Waiswa","sequence":"additional","affiliation":[{"name":"School of Public Health Makerere University Kampala Uganda"},{"name":"Global Health Department of Public Health Sciences Karolinska Institutet Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dilys","family":"Walker","sequence":"additional","affiliation":[{"name":"Institute for Global Health Sciences University of California San Francisco San Francisco CA USA"},{"name":"Department of Obstetrics, Gynaecology and Reproductive Sciences University of California San Francisco San Francisco CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,11,4]]},"reference":[{"key":"e_1_2_9_2_1","volume-title":"Trends in maternal mortality 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division","year":"2019"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)00837-5"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/0277-9536(94)90226-7"},{"key":"e_1_2_9_5_1","first-page":"1","article-title":"Barriers to access and utilization of emergency obstetric care at health facilities in sub\u2010Saharan Africa\u2010a systematic review protocol","volume":"7","author":"Geleto A","year":"2018","journal-title":"Syst Rev"},{"key":"e_1_2_9_6_1","unstructured":"World Health Organization.Intrapartum care for a positive childbirth experience.2018.http:\/\/apps.who.int\/iris\/bitstream\/10665\/260178\/1\/9789241550215\u2010eng.pdf?ua=1%0Ahttp:\/\/www.who.int\/reproductivehealth\/publications\/intrapartum\u2010care\u2010guidelines\/en\/. 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Accessed May 15 2020 ."},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0235269"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.15287"},{"key":"e_1_2_9_17_1","first-page":"1","article-title":"Factors influencing referrals for ultrasounddiagnosed complications during prenatal care in five low and middle income countries","volume":"15","author":"Floyd L","year":"2018","journal-title":"Reprod Health"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0063846"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.14933"},{"key":"e_1_2_9_20_1","doi-asserted-by":"crossref","unstructured":"The American College of Obstetricians and Gynecologists.The Use and Development of Checklists in Obstetrics and Gynecology Committee on Patience Safety and Quality Improvement. 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