Pregnant patients in the ED

Specialties Emergency

Published

Please send me your hospital policy on when an OB patient goes to OB and when they stay in ED. Our policy is 20+ weeks with ANY abdominal complaint that could be labor/complication of preg. goes to OB. (Obviously trauma abdominal complaints get treated in ED first). Now our hospital wants the ED to "screen" all OB's then send to OB if warranted. WE almost had a catastrope last week when a 37 weeker presented with back pain. OB finally accepted and noted late decels and went for STAT c-section. We do not have TOCO in ED, can only monitor fetal heart tones by stethoscope doppler.

Thanks in advance for all who help.

20 weeks they go up to ob for assessment and monitoring. Do you know how lont it has been since the ED doc delivered. they want nothing to do with them, unless it is obvious that it is not OB related- fx, etc. anything else goes to ob and then can come back to the ed it he see fit, I have not assisted in a delivery in eon :chuckle

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Specializes in ED, ICU, Coronary Care, Neuro.

20 weeks + here too with any abdo complaint.

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20 weeks they go up to ob for assessment and monitoring. Do you know how lont it has been since the ED doc delivered. they want nothing to do with them, unless it is obvious that it is not OB related- fx, etc. anything else goes to ob and then can come back to the ed it he see fit, I have not assisted in a delivery in eon :chuckle

I am about to start a job in the ED because our birthing unit is closing. How do you guys deal with OB pts when you don't have an OB dept? I know that our ED now sends OB's up to us SO fast it makes our heads spin, so now I will be on the other side of it and without any OB dept to fall back on. How many of you work in a hospital WITHOUT OB services? You must have to triage and treat before sending them to another hospital (say for preterm labor or PIH) unless she is going to deliver soon. I think it will be a mess once the OB dept closes in may.

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One hospital I worked at sent ALL 20+ to L/D regardless of the c/o, once got a girl who had cut her hand while washing dishes and needed sutures, and after we got her cleared the ER refused to take her back nevermind the fact that we didn't even have any normal suture kits on the floor, had to sort of gather stuff from here and there and let a FP 3rd yr resident sew her up LOL. Also had to tx sprained ankles, earaches, tooth aches you name it if they were 20+ weeks we got them, it was retarded.

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I don't know our policy, but I do know my daughter in law went to the ER with abd pain in her 19th week and the ER doc decided to break her water and induce her since he said it was "inevitable" that the baby would be lost. This was not the case, although after he got done there was nothing else to do. The OB was incensed that she was not sent to OB instead of them handling it.

And yes, the baby died two days later.

I think it depends on if your ER docs have sense or not.

OH MY GOD!! What was he thinking? Nobody questioned him?

I hope that there is a law suit filed against this idiot. I can't

imagine what was going through his mind. BAD BAD BAD DOCTOR!!

p.s. I am very sorry for your family's loss.

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Our policy is that if we can't get her shipped, we deal with it. We have no OB services and the closest OB is 35 long miles away. WE also pray alot

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Specializes in Going to Peds!.

Apparently, my hospital's policy is if you look pregnant, up to L&D you go. EVERY time I was pregnant and had an ER visit, I was immediately put in a chair & wheeled upstairs. But to be fair, I looked like I was having pg complications. PIH set in early on me and I was very swollen from about 12 weeks.

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20 weeks or more goes to OB Triage. Doesn't matter what they are complaining about. If WE, not ER, rule them out from an OB standpoint, then they can be seen in ER or clinics, etc.

Our OB building is separate from ER...so unless the pt's walk into the wrong building, even ambulance runs come to us first, we check 'em out...even if only by interview for dates, and if applicable, send them to ER.

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Specializes in Emergency, Cardiac, PAT/SPU, Urgent Care.
I am about to start a job in the ED because our birthing unit is closing. How do you guys deal with OB pts when you don't have an OB dept? I know that our ED now sends OB's up to us SO fast it makes our heads spin, so now I will be on the other side of it and without any OB dept to fall back on. How many of you work in a hospital WITHOUT OB services? You must have to triage and treat before sending them to another hospital (say for preterm labor or PIH) unless she is going to deliver soon. I think it will be a mess once the OB dept closes in may.

The hospital I used to work at did not have an OB unit and we used to get walk-in labor patients once in a while. The nearest facility with an OB unit was about 20 minutes away, but luckily most of the patients knew to go there. When we did get these patients, we would have to hook them up to the TOCO and interpret the fetal heart tracings - can I say big mistake waiting to happen?! Although we did take a fetal heart monitoring class, we never saw labor patients that frequently where we could be considered competent in fetal heart monitoring. Luckily, the manager who took over realized how risky this was and developed an agreement with the hospital that had the OB unit. They would send an L&D team to our facility as soon as we called them with a patient in a labor. A nurse and a resident would be transported via ambulance to our hospital and completely take over the care of the patient. Our ER docs were also family practitioners who did do deliveries with their practice, so if there was a precipitous delivery, they could handle it. We did have precip. packs, an infant warmer and all the other bare necessities but it was scary when we knew we had impending deliveries before the transport team thing was set up. Luckily, I only had one delivery during the 3 years I worked there. It was a small, rural facility - by the way.

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I also work in a small rural ER. We do the best we can to educate women in the community, but, inevitably there are going to be a few who don't listen. We have a fetal monitor and I shudder everytime we have to use it. I kinda know what to look for but I wouldn't want to bet my license on it. We just deliver and ship ASAP. If at all possible,we ship and let somebody else worry about it.

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Specializes in obstetrics(high risk antepartum, L/D,etc.

:chuckle -- I once worked in an OB dept that got ALL pregnant women.

One night, I received a non-English speaking lady who was all bent over in the w/c, and moaning and groaning, clutching her large abdomen. We couldn't even get close enough to her belly to try FHT. When our interpreter arrived, we found that she was #1 56 yoa, #2 having a gall bladder attack. We didn't receive any greif from the ER when we called and told them to come and get her.

We had a sliding scale OB clinic in the hospital. EVERY time we sent one of our patients for lab work, someone would scoop her up in a wheelchair, and take her to OB. One poor girl was so surprised! "I didn't know I was going to have my baby today!"

:roll

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Specializes in NICU/Neonatal transport.

As a patient, I know I was told to never go to the ER when I was pg. Go directly to L&D floor, do not pass Go, do not collect $200. They didn't want to touch me when pg (especially because I had chronic PTL issues. Even if I had something else going on, I was likely in labor and they didn't want to handle it.)

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