OB Triage

OB TRIAGE
RUCHITA PATEL
PGY 1
OB NIGHTS
INTRODUCTION
OB triage starts with the time patient first presents to the ED.
General Flow:
Clerk First intake
RN Second intake
No pcp and clinic pt Resident on call
OBGYN OBGYN on call
Resident Third intake

Clinic pt Call faculty to notify
No PCP Call OBGYN on call to notify
OBGYN
Reviews the A/P and provides feedback
BASICS
OB triage starts with the initial assessment, which should be
performed on every pt in the OB ED

Initial Assessment
Maternal Status
Fetus Status
Labor status
Psychological Needs
Prenatal Lab review
Initial Assessment
Maternal Status
CC and general HPI
Gravida and parity (GTPAL)
Vital signs
Estimated date of confinement
(EDC)
Estimated gestational age
(EGA)
Pregnancy risk factors
Current medications
Medication allergies
Nutritional status
o Fetus Status
o Fetal Movement
o Fetal Heart Tone
o Labor Status
o Uterine CTX (Date,
Frequency and onset)

o Membrane Status
CC: CTX
HPI: Age, GP, EGA
Onset, Frequency, intensity, spotting or leakage
Might say: Pelvic pressure, Cramping, vaginal pain,
backache
PE:
Vaginal Exam: Cervix dilation, effacement, station,
bleeding, lesion or fluid in fornix
If preterm <34 speculum over digital exam
If term obtain US to locate the placenta
If no previa Digital
If previa Transvaginal US
EFM - FHR and CTX
LABS:
Nitrizine test Dip swab in the post fornix for 10 mins
GBS collect sample from lower vaginal and perianal
area
Prenatal Labs (CBC, CMP, RPR, Rubella, Hepatitis,
ABO/RH, HIV)
UA, Urinalysis and UDS
Imaging:
ABD U/S (Fetal biometrics, AFI, Location of placenta, fetal
position)
Assessment: True vs false labor

If no changes in Cervix with ctx
then false
Plan:
Admit if
ROM
Vaginal Bleeding
Persistent CTX >6CTX/Hr
Dilation >3 &
effacement>80%
CC: ROM
HPI: Age, GP, EGA
Onset, Type of fluid, color and hx of prior ROM
Might say: Sudden gush of fluid from vagina, water
running down the legs, wetness to the underwear
PE: avoid frequent exam if suspecting PPROM
If no previa Digital vs speculum depending on
ROM onset
EFM - FHR and CTX
LABS:
Nitrizine test/Amnisure Test Dip swab in the post fornix
for 10 mins
GBS
ABO/RH, HIV)
Imaging:
ABD U/S (Fetal biometrics, AFI (Oligo), Location of
placenta, fetal position)
Assessment:
PPROM VS ROM VS no ROM
Plan:
Admit if PPROM (ROM < 34
weeks) for abx and bedrest
Admit if ROM > 34 for IOL
Discharge if no ROM with close
f/u after reassuring FHR
CC: Vaginal bleeding

HPI: Age, GP, EGA
Onset, Severity, Associated symptoms, eliciting factor
Think of: labor, cervical lesion, infections, genital and
cervical trauma, placenta previa and placental abruption
PE:
bleeding location (internal os vs external os)
EFM - FHR and CTX
LABS:
Significant bleeding PT/PTT, fibrinogen, KB
area
ABO/RH, HIV)
Imaging:
ABD U/S (Fetal biometrics, AFI, Location of placenta,
Assessment: Infection vs Placenta

Previa vs Placental Abruption vs labor
Plan:
Give RHIG if RH
Admit if
Placenta pervia and >34 wks
Placenta Abruption for
Delivery
Labor
Discharge if
Infection UTI vs STDs with
ABX
Cervical lesion F/u with
OBGYN
CC: Decreased FM
HPI: Age, GP, EGA
Onset, frequency, interval and spotting or leakage
Might say: Have not felt baby move for 2 days
Things to consider: IUFD, and/or quiescent state
Normal: Ten distinct FM in 2 hours
Abnormal: No FM for >12 hrs, <3 FM in 1hr, <10 FMs in 2
hrs
PE: EFM - FHR and CTX
DR C BRAVADO
Risk , CTX
Baseline Rate
Variability
Acceleration or Deceleration
Overall
LABS:
NST and AFI (Modified BPP)
If normal Discharge
If abnormal Vibroacoustic device or Full BPP
Imaging:
ABD U/S (Fetal biometrics, AFI (Oligo), Location of
placenta, fetal position)
Assessment: IUFD vs Normal vs

Sleepy baby
Plan:
Admit if
Oligohydramnios
Persistent nonreactive NST
Nonreassuring Fetal testing
Discharge
Normal NST and AFI
Instructions:
Lie on left side with hand
on the stomach
Count FMs daily any time
in the evening for 1
atleast 1hr
CC: HTN
HPI: Age, GP, EGA
HA, Abd pain in RUQ, Scotomata, Visual Changes,
Excessive Swelling, Decreased FM, Vaginal Bleeding
and/or CTX
Think of: Chronic Vs New onset HTN
PE:
Vitals: mainly BP. Edema in Lower ext.
Allow 30 mins to pass if smoker or caffeine intake
bleeding location
EFM - FHR and CTX
LABS:
CBC (hgb/HCT/Platelet) CMP (Cr, AST, ALT), LDH and
Uric Acid
UA for urine protein, Protein to Cr Ratio
ABO/RH, HIV)
Imaging:
ABD U/S (Fetal biometrics, AFI, Location of placenta,
fetal position)
Assessment: Preeclampsia vs Chr

HTN vs eclampsia
Preeclampsia SBP>140 and
DBP>90 with 1+ protein on urine dip
Plan:
Admit if >37 for IOL
Admit if <37 and if severe
preeclampsia for bed rest and
mg sulfate
Discharge if negative workup
with close f/u
CC: Prenatal Care

HPI: Age, GP, EGA
CTX: Onset, Frequency, intensity,
Vaginal: spotting or leakage
Might say: N/V or Diarrhea or any other vague complain
PE:
EFM - FHR and CTX
LABS:
area
ABO/RH, HIV, wet mount)
Imaging:
ABD U/S (Fetal biometrics, AFI, Location of placenta, fetal
position)
Assessment: No prenatal Care

Plan:
Admit if
ROM
Vaginal Bleeding
Persistent CTX >6CTX/Hr
Dilation >3 &
effacement>80%
Infection Pyleo,
complicated UTI, and/or
Trauma
Or any other risk factor that
requires urgent
considerations
Discharge
With F/u with south clinic or
reg clinic with clinic card.
Ask to return to ED if any
other complains
Resources
Uptodate OB topics
OBGYN Comprehensive handbook by Thomas Zheng
MD, 2nd Edition

OB Triage

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OB TRIAGE

Resident Third intake

performed on every pt in the OB ED

Frequency and onset)

Assessment: True vs false labor

CC: Vaginal bleeding

Assessment: Infection vs Placenta

Assessment: IUFD vs Normal vs

Assessment: Preeclampsia vs Chr

CC: Prenatal Care

Assessment: No prenatal Care

MD, 2nd Edition

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