ED sending patients to L&D

Specialties Ob/Gyn

Published

At what gestational age does the average Emergency Department (ED) send a mom to L&D?

Does the ED always stick to hospital protocal?

We had a pregnant lady not too long ago come up from ER who, when we started getting her OB history, was like, "Um, I just sprained my ankle..." Got a quick NST and sent her right back down to ER. Now really...

Anybody pregnant comes up to L&D at our hospital; there is no cutoff.

I'll never forget when I broke my toe @ 32 weeks and they wanted to send me to L&D. I refused because it was asinine. I bumped my toe on a table! ER doc said it was OK for me to stay in the ER. Gee, thanks!

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Specializes in ER, ICU, Infusion, peds, informatics.

the hospital i just left, it was 20 wks, no exceptions. i had a pt that wheeled out to 19 wks 6/7 (at 10pm), and l/d refused to see her because she wasn't 20 wks yet. they just didn't budge at all on the whole dates thing.

i totally understand that l/d can't really do anything to stop a miscarriage at 20 wks anyway, but it seems to awful to have women going through that in the ed.

and, the c/o had to be pregnancy-related. they could be term, and the asthmas/broken bones/mvas stay in the er. might get sent up to l/d afterwards for monitoring (for the mvas at least), but get seen first in the er.

if they got admitted at

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Specializes in Nephrology, Cardiology, ER, ICU.

Critterlover - I think we worked at the same hospital. Had a lady come in with known twin gestation at 17 weeks with cramping. We wanted so desperately to send her to L&D but nope, "she's only 17 weeks, deal with it." So...we delivered footling breach twins that moved! It was one of the worst things I have ever experienced in the ER. The poor parents were dumbfounded. We wrapped them in a warm blanket and let them hold the children - it was so sad. Our ER is not private at all - everyone knew there had been a death and the poor mother was truly beside herself. At least in L&D they could have had privacy for their grief.

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Specializes in Community, OB, Nursery.

Oh, it drives me crazy. I work on mother/baby, postpartum, gyn, and antepartum. If someone is

It's bad enough to do it in a private room, I can't imagine doing that in an ER, traumaRUS. Horrible.

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We do have the exception to the rule 20 weeks being the rule but if you have somebody at 17 weeks that is really miscarring we take them or fetal demise at that age also just because we handle that but a 6 weeks bleeding nope not in labor. There is a bit of a judgement call to it.

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Specializes in Nephrology, Cardiology, ER, ICU.

Thank you Arwen and cassioo - it was horrid. THis incident occurred about 8 years ago and I still remember it. I provided what I could, but I will never feel that it was enough. I know those poor parents remember that night too.

We are suposed to be in this for the patient. In our ER, 20 weeks was the magic cut-off too. Sometimes exceptions must be made.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

IN such cases, Trauma, these patients absolutely would be up on my unit, where they belong. There is nothing more horrid than losing a pregnancy in the ED, trust me. It will never be forgotten. And it's so unfair the ED staff, who are not really able to deal with the intricacies of such delicate events.

Also, clearly, a twin gestation/loss at this point, could definately be complicated and need our (OB's) attention anyhow. I hate when people cannot and will not think outside the box, and see that there are exceptions to every "rule".

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Specializes in Emergency Nursing.

I'm not an OB nurse, but when I was pregnant, I was in the ER 4 times (once with pneumonia, once after a car accident and twice with PTL). EVERY SINGLE TIME I came into the ER, after making sure I was stable, I was immediately sent to L&D for an hour of monitoring before I could be sent back to the ER for evaluation of my other injuries/issues. They said it was hospital policy for ANY pregnant patient, regardless of gestational age, to be sent to L&D for an hour of monitoring immediately after being deemed stable.

ETA: This was a HUGE pain, both for myself (the patient) and the busy nurses in the L&D unit...

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Specializes in postpartum, nursery, high risk L&D.
I'm not an OB nurse, but when I was pregnant, I was in the ER 4 times (once with pneumonia, once after a car accident and twice with PTL). EVERY SINGLE TIME I came into the ER, after making sure I was stable, I was immediately sent to L&D for an hour of monitoring before I could be sent back to the ER for evaluation of my other injuries/issues. They said it was hospital policy for ANY pregnant patient, regardless of gestational age, to be sent to L&D for an hour of monitoring immediately after being deemed stable.

ETA: This was a HUGE pain, both for myself (the patient) and the busy nurses in the L&D unit...

I wish we could come down to the ER to monitor patients. it just seems like much less of a hassle, for everyone.

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Our ER attempts to send everyone up to us for evaluation first. Ridiculous in the case of broken ankle and no trauma to abdomen or c/o contractions, I also had a patient whose main complaint was chest pain. We have to call in an OB from home to evaluate now and precious time could be wasted. Often we do go down just to assess FHTs ( sorry, we can't hear them if the patient is 6 weeks pregnant.......and what difference does it make at that point in time ?? ) Years ago as a new L & D nurse, I got a call from ER saying that a 32 weeker with twins was on her way in by ambulance, bleeding, seizing and no one could start an IV. My first response was that they were going in the wrong direction ( being an equal distance to a tertiary care facility ). The ER then said that they would be bringing her right up to us !! Which they did. "Luckily" she was a psych patient and not even pregnant !! I had called in an extra nurse envisioning potential codes on preemie babies. The nurse turned out not to be needed ( but paid for 4 hours for being called in )and I was questioned the next day regarding my actions. Thankfully I had a wonderful manager at the time and things were straightened out with ER and protocols etc.

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Specializes in postpartum, nursery, high risk L&D.
I also had a patient whose main complaint was chest pain. We have to call in an OB from home to evaluate now and precious time could be wasted.

EXACTLY. that has happened to me more than once too, it's always a hair-raising experience.

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Specializes in med-surg OB.

we have had the same problem with our ecc sending anyone pregnant to our ldrp unit. they have sent up "unclean" pts (vomiting ,diarrhea, open sores etc..) over and over again have re told them we are a closed unit and have newborns with limited immunities stop sending us sick women who need a med doc not an ob. two particular cases that frosted me. one night ECC sent a 26 weeker to me with complaint of severe headache, double vision and left sided weakness. i auscltated the baby for about twenty seconds did quick neuro checks and one of our staff bring her back to ECC as i called the supervisor. The more disturbing case was a 34 week pregnant woman who presented to them with chest pain and shortness of breath.This patient had just been released two days before, she had been in for coagulation therapy for a dvt. and the icing on the cake they had her walk to our unit.:angryfire

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