ED Nurse Needing Advice Regarding PROM

[Jen2]

Hello fellow nurses! I am an ED nurse in a very busy Level 1 Trauma Center. It is hospital policy that if a pregnant patient comes in through triage and is less than 20 weeks pregnant, she must be seen in the ED first. A few weeks ago we had a young lady who was a high risk patient pregnant with twins come in through triage leaking fluid. The lady was three days away from being 20 weeks and our triage nurse called up to OB to see if we could send her up and they wouldn't take her because she was not 20 weeks yet and stated that the fluid may be urine.

I am a new nurse in the ED and the patient was brought back to me and the only thing that I could remember was the Nitra-Paper test. I established I.V. access, drew labs, assessed FHT's with a doppler getting heart rates of 130 and 138, and tested the lady partsl pH with the paper which came back to be positve. I quickly reported my findings to the ED attending and she called up to OB and they accepted the patient. I then transported her up with the labs labeled and a copy of the chart.

My questions are as follows:

How accurate is the pH test?

Do you feel my actions/assessment was appropriate for the situation? I am trying to figure out what I can do or better assess these types of situations. OB is not my specialty but we often run into problems with OB patients in the ED and I would like to make an accurate assessment on these types of situations. What can we as ED nurses do to help out the OB nurses in these types of situations? Thanks for reading and all advice/comments are welcomed.

[canoehead, BSN, RN]

I think you acted appropriately. about 90% of the time the Nitrazine test is effective although I have run across women who have a urinary pH of 7-8 it is usually around 5. The kicker is that in most areas they can't do anything for the baby (s) until they are 24-25 weeks, so accepting at 20 weeks is generous, and possibly she got upstairs to be told that if the babies decided to come they would not do well at all. However, the woman has a right to hear that from her own OB/GYN I think, instead of the triage nurse.

[Jen2]

Thanks canoehead! We do have a state of the art NICU at my hospital which is probably why they accept at 20 weeks to at least try. If those babies were comming I would rather have them come upstairs where the situation could be better handled than in the ED. I respect the OB nurses so much. We often have unviable fetus born in the ED and it is never easy for me. Thanks.

[SmilingBluEyes]

What do your policy/procedures books in OB and ED say? A few days from 20 weeks, and twins, we would have had to take the patient in OB, due to her risk status and being that close. No the babies are not viable, but it's still up to us to care for such a case. I would recommend the policy/procedure books be looked at for the answers you seek, and if there is no clear policy, then approach your NM in ED to have one designed with OB input.

Good luck; thank you for caring. Such cases are horribly hard to deal with, even for us OB nurses. It's really hard for your folks in ED, I just know.