OB Triage
OB Triage
OB Triage
RUCHITA PATEL
PGY 1
OB NIGHTS
INTRODUCTION
OB triage starts with the time patient first presents to the ED.
General Flow:
Clerk First intake
RN Second intake
No pcp and clinic pt Resident on call
OBGYN OBGYN on call
BASICS
OB triage starts with the initial assessment, which should be
Initial Assessment
Maternal Status
CC and general HPI
Gravida and parity (GTPAL)
Vital signs
Estimated date of confinement
(EDC)
Estimated gestational age
(EGA)
Pregnancy risk factors
Current medications
Medication allergies
Nutritional status
o Fetus Status
o Fetal Movement
o Fetal Heart Tone
o Labor Status
o Uterine CTX (Date,
CC: CTX
HPI: Age, GP, EGA
Onset, Frequency, intensity, spotting or leakage
Might say: Pelvic pressure, Cramping, vaginal pain,
backache
PE:
Vaginal Exam: Cervix dilation, effacement, station,
bleeding, lesion or fluid in fornix
If preterm <34 speculum over digital exam
If term obtain US to locate the placenta
If no previa Digital
If previa Transvaginal US
EFM - FHR and CTX
LABS:
Nitrizine test Dip swab in the post fornix for 10 mins
GBS collect sample from lower vaginal and perianal
area
Prenatal Labs (CBC, CMP, RPR, Rubella, Hepatitis,
ABO/RH, HIV)
UA, Urinalysis and UDS
Imaging:
ABD U/S (Fetal biometrics, AFI, Location of placenta, fetal
position)
CC: ROM
HPI: Age, GP, EGA
Onset, Type of fluid, color and hx of prior ROM
Might say: Sudden gush of fluid from vagina, water
running down the legs, wetness to the underwear
PE: avoid frequent exam if suspecting PPROM
Vaginal Exam: Cervix dilation, effacement, station,
bleeding, lesion or fluid in fornix
If preterm <34 speculum over digital exam
If term obtain US to locate the placenta
If no previa Digital vs speculum depending on
ROM onset
If previa Transvaginal US
EFM - FHR and CTX
LABS:
Nitrizine test/Amnisure Test Dip swab in the post fornix
for 10 mins
GBS
Prenatal Labs (CBC, CMP, RPR, Rubella, Hepatitis,
ABO/RH, HIV)
UA, Urinalysis and UDS
Imaging:
ABD U/S (Fetal biometrics, AFI (Oligo), Location of
placenta, fetal position)
Assessment:
PPROM VS ROM VS no ROM
Plan:
Admit if PPROM (ROM < 34
weeks) for abx and bedrest
Admit if ROM > 34 for IOL
Discharge if no ROM with close
f/u after reassuring FHR
CC: Decreased FM
HPI: Age, GP, EGA
Onset, frequency, interval and spotting or leakage
Might say: Have not felt baby move for 2 days
Things to consider: IUFD, and/or quiescent state
Normal: Ten distinct FM in 2 hours
Abnormal: No FM for >12 hrs, <3 FM in 1hr, <10 FMs in 2
hrs
PE: EFM - FHR and CTX
DR C BRAVADO
Risk , CTX
Baseline Rate
Variability
Acceleration or Deceleration
Overall
LABS:
NST and AFI (Modified BPP)
If normal Discharge
If abnormal Vibroacoustic device or Full BPP
Imaging:
ABD U/S (Fetal biometrics, AFI (Oligo), Location of
placenta, fetal position)
CC: HTN
HPI: Age, GP, EGA
HA, Abd pain in RUQ, Scotomata, Visual Changes,
Excessive Swelling, Decreased FM, Vaginal Bleeding
and/or CTX
Think of: Chronic Vs New onset HTN
PE:
Vitals: mainly BP. Edema in Lower ext.
Allow 30 mins to pass if smoker or caffeine intake
Vaginal Exam: Cervix dilation, effacement, station,
bleeding location
EFM - FHR and CTX
LABS:
CBC (hgb/HCT/Platelet) CMP (Cr, AST, ALT), LDH and
Uric Acid
UA for urine protein, Protein to Cr Ratio
Prenatal Labs (CBC, CMP, RPR, Rubella, Hepatitis,
ABO/RH, HIV)
UA, Urinalysis and UDS
Imaging:
ABD U/S (Fetal biometrics, AFI, Location of placenta,
fetal position)
Resources
Uptodate OB topics
OBGYN Comprehensive handbook by Thomas Zheng