Obstetrics Book




Emergency Department Active Labor Presentation

Aka: Emergency Department Active Labor Presentation, Labor Phone Triage
  1. History
    1. Demographics (if phone triage)
      1. Patient name and age
      2. Distance from hospital
      3. Primary obstetrics provider
    2. Pregnancy History
      1. Parity
      2. Gestational age and estimated delivery date
      3. Prenatal Course and past obstetrics history
        1. Twin Gestation
        2. Prior cesarean (planned repeat cesarean or VBAC)
        3. Gestational Diabetes
        4. Breech Presentation
        5. Placenta Previa
        6. GBS Positive status (36 week culture result)
    3. Contraction history
      1. Onset
      2. Frequency
      3. Duration
      4. Intensity
    4. Associated obstetric symptoms
      1. Rupture of Membranes (and is there meconium staining)
      2. Fetal movement
      3. Vaginal Bleeding
    5. Other symptoms
      1. Fever or concurrent illness
      2. Oral intake
  2. Indications: Evaluation at Labor and Delivery (via phone triage)
    1. General
      1. Unable to speak during 2 contractions during triage
      2. Suspected Rupture of Membranes
    2. Nulliparous patient
      1. Contractions every 5 minutes
    3. Multiparous patient
      1. Contractions every 8-10 minutes
  3. Exam
    1. Fetal Heart Rate
      1. Fetal Heart Tracing (if available)
    2. Contraction frequency
    3. Cervix exam
      1. See Cervical Examination in Labor
      2. Cervical dilation (closed to completely dilated at 10 cm)
      3. Cervical effacement (Cervical Length)
      4. Fetal Presentation (vertex or Breech Presentation)
      5. Fetal Position (Occiput Anterior or Occiput Posterior)
  4. Management
    1. See Spontaneous Vaginal Delivery
  5. Complications
    1. First Stage of Labor
      1. Fetal Distress
    2. Second Stage of Labor
      1. Fetal Malpresentation
      2. Breech Presentation
      3. Umbilical Cord Prolapse
      4. Shoulder Dystocia (and Shoulder Dystocia Management)
      5. Uterine Rupture
      6. Uterine Inversion
    3. Third Stage of Labor
      1. Postpartum Hemorrhage
      2. Retained Placenta
  6. References
    1. Doty in Herbert (2016) EM:Rap 16(5):3-4

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