What gestational age comes to your unit?

[JenniferNRN]

I am very curious as to what other hospital policies are on this subject and what your opinions as ob nurses are.

our hospital is a rural one, doing about 150-200 births per month. I work nights on the weekend and we don't have an ob in house. many of our pt's don't see a doctor until morning, or at all if they are d/c'd by phone order.

The hospital is also very short on money so most units are understaffed and overworked, including the ed. In order to help the ed out, we are now required to take pt's with gestational age of 12-20 weeks, with an ob complaint (ie: vag bleeding, fluid leaking, abd. pain), after they have been seen by an ed physician. the old policy was 20 weeks or above.

One problem we have with this are that we are sometimes so understaffed as well that we are overwhelmed with these new pt's. we also have ed calling to say pt is "3 months", and if the person taking report doesn't have the foresight to question, the pt comes up, we wheel her out, and she is 11 weeks. at this time, we have accepted her and everything turns into a battle of wills between us and the ed.

Another problem is that we don't have any protocols/policies for pt's under 20 weeks. I know how the docs in our ed are and even though they have "evaluated" these pt's, I know they want to get them up to us asap to avoid dealing with them, and I'm worried that we are going to end up with an ectopic or some kind of emergency that we haven't seen before. Most of our ob's are at least 20 minutes away, if not more.

My question is: at what gest. age does your unit accept pt's, and what kind of policies/protocols do you have in place? I'm also curious as to what you have experienced if you take pt's of a lower gest. age, and to what your thoughts are on it.

Thanks for your input and for allowing me to vent a bit!

[SuperFlyRN]

Jennifer-

Our unit is sub-divided. We have a LDRP where are normal, uncomplicated laboring mom's go and some admits for PP/Sections for recovery. We have a High-Risk L&D where the GD's, PIH, fetal demises and etc go. Our other unit (Antepartum/PP unit) is mainly antepartums that are on bedrest for various reasons. We used to have patients go through our ED but recently (within the past year) we have an OB Triage where patients are assessed and directed accordingly. They do have a 23hour assessment area for short stay observattion. For admitted patients that are 20 weeks and under go to our Gyn Surg unit regardless of reason here-we assess FHR Q shift. For 20 weeks and over if it is pregnancy related, they go to our other unit-the Antepartum/PP unit) for 20 weeks and above that is non-pregnancy related, they go to the Gyne Surg unit. All demises go to HighRisk and once delivered get moved to the Gyne surg unit. These policies change almost monthly it is crazy. Oh, BTW, we have *about* 250-300 delivieries a month.

Jennifer

[SuperFlyRN]

Jenn-

Sorry if it wasn't that clear-hope this helps. As always, more nurse and better policies/procedures would help.

[LandDRN]

We accept 20weeks and greater from our ER. They do not treat anyone over 20weeks even for non pregnancy related things ( colds, coughs, asthma attacks, ect.)All others go to ER. Part of the rational is that our birthing unit was just redone 2yrs ago to expand and we have already outgrown it. Under 20 weekers are triaged downstairs and should they need to be admitted they usually go to the womens health unit. The additional rational as given by the hospital for under 20 weekers is that these babies are "not able to be saved" and also to avoid any emotional distress for the parents having to come to the labor and delivery unit for a miscarriage especially since beds and nurses are scarce and missed ABs are so common. Occasionally we get a 18-20 weeker in for cytotec induction due to IUFD. We also have the "month problem". We commonly have someone say they're five months only to admit them for observation and they're 18.5weeks and we're then entitled to triage them ( again this is a bed/staff problem). The bed issue gets particularly problematic ( again because we are all one unit with only labor rooms and no triage area) because we have an extremely large illegal immigrant population here. They're scared to seek regular medical help because of this and also a language barrier and will come to the hospital only if they need treatment when they think it is emergent so we triage alot of people with common pregnancy issues that just need some education ( white vag discharge, linea nigra that some poor scared girl thought was an allergic reaction) and other things like yeast infections, colds , ect. Since we don't have a seperate triage area these pt are put into labor rooms. We also transfer out any stable PTL, severe PIH, ect pts that are under 30weeks to another nearby hospital since we have only a level 2 NICU.

[SmilingBluEyes]

We take them 20 weeks and up for triage. Less than that, they are seen by ED---but if experiencing a demise or ectopic, will eventually be admitted to our unit for care.

[rpbear]

Same here, 20 weeks and up. We do take demises that have not yet delivered, they deliver on L&D and then go to GYN floor. We have a ante floor that takes anything pregnancy related no matter what the gestational age, and any one 20 weeks and up with any medical problem.

[gcrhodenrnc]

Same here, 20 weeks and up come to our L/D unit, otherwise, they should be taken care of in the ED. We have had the same problem with ED trying to send us a patient that is 5 months to find out she is 18-19 weeks. Our OB's really get upset when they come up to L/D because that means they now are the doc in charge of them, whereas if they're treated in the ED, the ED doc takes care of them.

The ED occasionally will see people that are over 20 wks pregnant for things not pregnancy related, ie: asthma attacks, MVA's, flu...but most of the time even these get turffed to us.

We do occasionally get the 18 week IUFD that is being cytotec induced or a 18 week PPROM that wants to maintain her pregnancy. Those we usually ship to our high risk hospital across town.

Hope this helps.

[JenniferNRN]

Thanks for all of the responses. I appreciate the input. I have learned that it is a little more common than I thought to take those under 20 weeks, and of course, our units are all so different as far as having a triage area or ante unit. I love how much we can learn from each other here.

[RNnL&D]

We are SUPPOSED to get those over 20 weeks with a pregnancy related issue. I have learned that there will always be issues between OB and ER regardless of what policies are in place. We'll always think they

We also get alot of non OB related complaints. Technically, they should at least be minimally assessed in ER to determine if it is a serious health concern. Like the pt I had who slipped and cracked her head on a marble floor. She was 24 weeks so they sent her right up without even doing a neuro check. :uhoh21:

If the less than 20 weekers slip through, we don't really mind. It's when they call to tell us about the 32 week pt c/o of chest pain... can you come get her? Uh, maybe after you assess her chest pain. Or this week, a 31 weeker who had 3 seizures while in the ER. Her BP's were stable, just had an unstable seizure disorder. The OB told them it wasn't pregnancy related, and she needed to go to Neuro.