1. Killion, Molly M. MS, RN, CNS

Article Content

The American College of Obstetricians and Gynecologists (ACOG, 2016) recently recommended obstetric (OB) units develop guidelines to triage pregnant women and suggested using a validated OB acuity system such as the Association of Women's Health, Obstetric and Neonatal Nurses' (Ruhl, Scheich, Onokpise, & Bingham, 2015) Maternal Fetal Triage Index. Triaging patients to determine acuity and allocate resources began in the United States during the Civil War. Triage tools are frequently used in emergency departments; however, only recently have similar tools become available for OB patients (Ruhl et al.). In OB, the term "triage" refers to more than the initial brief assessment (Association of Women's Health, Obstetric, and Neonatal Nurses [AWHONN], 2010; Ruhl et al.). Obstetric triage usually involves a thorough maternal fetal evaluation and may include treatment and a several hour length of stay. Many women who present to OB triage receive various types of care before disposition.


Generally, OB triage volume will be about 20% to 50% higher than total hospital birth volume with most women presenting for presumed labor at term; however, women may also be seen for preterm labor, preterm premature rupture of membranes, preeclampsia symptoms, decreased fetal movement, trauma, bleeding, or any other possible medical condition related or unrelated to pregnancy (ACOG, 2016). Women who present for scheduled procedures are not usually counted in OB triage volume numbers. Perinatal services with a large number of women with high-risk pregnancies may have a significantly higher patient volume in OB triage than low-risk centers (AWHONN, 2010). When a woman presents to OB triage, there are several initial data points that must be rapidly assessed including the woman's reason for seeking care, fetal status, uterine activity, vital signs, OB and medical history, and possible vaginal leaking or discharge (AWHONN; Ruhl et al., 2015). These data guide clinicians to determine acuity and treatment needs, if any. Priority for care should be based on acuity rather than order or time of arrival (ACOG; AWHONN). A validated OB triage acuity tool may assist in improving quality and efficiency of care, as well as resource allocation (ACOG; Ruhl et al.). Nurse staffing needs may be predicted with accurate data on OB triage acuity (AWHONN).


The Maternal Fetal Triage Index (MFTI) (Ruhl et al., 2015) offers a standard method of assigning an acuity score to pregnant women presenting to the hospital for care. It is thought to be the first OB triage acuity tool validated for multidisciplinary use (Ruhl et al.). The MFTI uses a five-tiered approach to categorizing acuity. The five-level Emergency Severity Index has been found to be more reliable and easier to use and to communicate results than a three-level acuity scale (Ruhl et al.). The five tiers are: "1-Stat" requires immediate lifesaving intervention for a woman or her fetus; "2-Urgent" includes severe pain not related to contractions, high-risk clinical condition, and/or the need for transfer to a higher level of care; "3-Prompt" includes women at or over 34 weeks gestation in active labor; "4-Non-Urgent" includes women at term gestation in early labor; and "5-Scheduled or Requesting a Service" includes women presenting for scheduled procedures or routine prenatal care (Ruhl et al.).


Collaboration by OB nurses, physicians, and midwives with the clinical teams in the emergency department, other hospital-based ancillary medical and surgical services, and emergency response systems (such as ambulance services) outside of the hospital is critical to safe and comprehensive triage of pregnant patients (ACOG, 2016). Consultation with these stakeholder groups is essential when considering adoption of the MFTI.


For more information, see (AWHONN, 2016) and (ACOG, 2016).




American College of Obstetricians and Gynecologists. (2016). Hospital-based triage of obstetric patients (Committee Opinion No. 667). Obstetrics and Gynecology, 128(1), e16-e19. doi:10.1097/AOG.0000000000001524 [Context Link]


Association of Women's Health, Obstetric, and Neonatal Nurses. (2010). Guidelines for professional registered nurse staffing for perinatal units. Washington, DC. [Context Link]


Association of Women's Health, Obstetric, and Neonatal Nurses. (2016). Maternal fetal triage index. Washington, DC. [Context Link]


Ruhl C., Scheich B., Onokpise B., Bingham D. (2015). Content validity testing of the maternal fetal triage index. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 44(6), 701-709. doi:10.1111/1552-6909.12763 [Context Link]