Everyone — initial workup:
- •GPs and GA
- •Last note for pregnancy complications, medical / surgical / social history, allergies
- •Placenta location
- •Delivery history
- •Triage vitals and NST
- •Presentation with BSUS
- •The 4 Q’s: bleeding, cramping, loss of fluid, movement
- •Clean up speculum, ultrasound, and swabs.
- •Exam and confirm presentation.
- •Be ready with a one-liner, brief HPI, exam (vitals, NST, SVE when appropriate), and your suggestion for plan / disposition.
Term labor evaluation:
- •NST — fetal wellbeing (reactive?) / contractions?
- •SVE
- •Ultrasound for fetal position
- •Collect GBS if not on file
- •History of C-section → determine candidacy/desire for TOLAC; TOLAC patients need a separate consent on admission
- •Disposition: <3 cm → home with labor precautions · 2–4 cm → recheck in 1–2 hr · ≥5 cm → admit to L&D
Term rupture of membranes:
- •Speculum exam (don’t use gel — risk for false positive): pooling, nitrazine (blood and semen → false positives), slide for ferning
- •SVE / ultrasound to check for position
- •If rupture confirmed → admit to L&D for induction / augmentation. History of C-section → TOLAC consent vs. repeat C-section consent
Decreased fetal movement:
- •NST
- •AFI
- •If term → consider delivery
- •If preterm → consider in-triage monitoring vs. admission (based on NST)
Vaginal bleeding (3rd trimester):
- •Ask about recent intercourse.
- •ROM workup.
- •Each Fox swab is 5 mL.
- •DDx: UTI, abruption (ask about drug use), ROM, labor, nothing.
Non-labor abdominal pain:
Consider: biliary issue, appendicitis, pancreatitis, pyelo, UTI, abruption, labor, round ligament pain.