Labor and Delivery Info

Note

There should be a provider to provider phone call to the Laborist at 77444 before patients are transferred to L&D. The Laborist will communicate to the patient’s physician as needed.

Specific Guidelines

• When postpartum patients check into the ED with initial/triage BP >160/110 and preeclampsia concern we can send these patients directly up to PSU (perinatal support unit) with just a single call to the Laborist without further preeclampsia work up in the ED

• When postpartum patients check into the ED with elevated BP <160/110 and concern of preeclampsia AND the ED is overcrowded with limited resources causing a delay in the patient’s care, you can call the Laborist and they may be able to accept the patient directly to the PSU for preeclampsia work up in that unit instead of the ED. Again, requires ED doc/APP to Laborist call. (If not overcrowded or no perceived delay in care, we should work up in the ED)

• When postpartum patients with concerns of preeclampsia present to the ED with normal BPs we work them up in the ED.

• When postpartum patients (s/p epidural) arrive to the ED who we determine have a spinal headache, those needing a blood patch evaluation can be sent to PSU for assessment and treatment by anesthesia in that unit. Requires an ED doc/APP to Laborist call.

• When we have a term (or >20 week) patient that we are admitting for ONLY medical reasons that have NO OB related conditions discuss with medicine/hospitalist team first.

  • If they are uncomfortable with admission, then call and discuss with Laborist (consider discussing with patient’s OB if assigned, but do not call EMTALA OB).
  • Some examples: stroke, primary cardiac, syncope, respiratory, MSK, etc.
  • The Laborist will either accept to their unit if appropriate or they will call the hospitalist to discuss amongst themselves who will accept the admission and to what unit.
  • They will then notify us of the accepting team.

General Guidelines

• These guidelines were set in place with the help of Dr. Reed, Dr. Rogers, Dr. Depew, and Dr. Grizzell. We will be following these practices effective immediately.

• For a patient claiming to be pregnant and >20 weeks, and presenting with an obstetrical complaint: will be initially evaluated in PSU. Patient will be transferred back to ED for evaluation if it is determined that she is not pregnant.

• Fetal Demise patients that have miscarried and require a D&C should go to PACU and then the surgical floor if required (approximately <15 weeks gestation). Fetal Demise patients that will deliver vaginally should go to LDR (approximately >15 weeks gestation). You may need to communicate with the patient’s physician to help guide where the patient should go.

• Hypertensive, pregnant patients <20 weeks will need evaluation in the ED first. If treatment requires Magnesium, then they will transfer to LDR. Hypertensive pregnant patients that are >20 weeks will transfer to LDR.

Pregnant patients >20 weeks with an obstetrical-related complaint should go straight to PSU.

Potential Obstetrical-related complaints include, but are not limited to:

• Headache

• Hypertension (defined as anything >140/90)

• Any kind of abdominal complaint (including, but not limited to pressure, back pain, flank pain, cramping)

• Vaginal bleeding

• Leakage of fluid

• Decreased fetal movement

• Contractions

• Urinary symptoms

Pregnant patients >20 weeks that will need to be evaluated in the ED first.

• Stroke-like symptoms

• Primary cardiac symptoms (such as chest pain/Shortness of breath)

• Isolated orthopedic or musculoskeletal injuries/complaints

• Loss of consciousness

• Respiratory symptoms such as cough, cold, congestion.​

Postpartum patients

• Complaints of a headache need to be evaluated in the ED first. Postpartum is defined as a patient that has delivered a baby within the last 6 weeks.

• Any complaints of abdominal pain, vaginal pain, bleeding, etc need to be evaluated in the ED regardless of how recently postpartum.

• If concerned for postpartum preeclampsia or eclampsia, or if diagnosis is a spinal headache requiring a blood patch, the patient may be transferred to PSU for treatment.