eMedicine Specialties > Emergency Medicine > Obstetrics & Gynecology

Pregnancy, Delivery: Differential Diagnoses & Workup

Author: Thomas E Benzoni, DO, Medical Director of Mercy Air Care; Consulting Staff, Department of Emergency Medicine, Mercy Medical Center; Member, Board of Directors, Iowa Medical Society
Contributor Information and Disclosures

Updated: Oct 21, 2009

Differential Diagnoses

Appendicitis, Acute
Cholecystitis and Biliary Colic
Pregnancy, Breech Delivery
Pregnancy, Eclampsia
Pregnancy, Ectopic
Pregnancy, Preeclampsia

Workup

Laboratory Studies

  • Few laboratory tests are useful.
  • Initial determination of the patient's hemoglobin level and Rh blood group status is required.
  • If the patient has received prenatal care, other laboratory tests have been performed.
  • Kleihauer-Betke testing can be ordered after delivery for Rh-negative mothers of Rh-positive infants. (One unit of Rh immunoglobulin per 15 mL fetal blood in the mother's circulation is administered intramuscularly within 72 h of delivery.)

Imaging Studies

  • Generally, if sufficient time for imaging studies exists, time to transport the patient to the obstetrics ward exists.
  • Ultrasonography may be useful and is immediately available at most facilities as FAST tools become increasingly available. Depending on the sophistication of the equipment and personnel available, sonography may be used to determine the following:
    • Fetal position
    • Number of fetuses and/or age of the fetus
    • Presence of cardiac activity
    • Fetal malformation (eg, CNS, developmental)
    • Quantity of amniotic fluid
    • Estimation of fetal weight
    • Hydatiform mole
    • Rh isoimmunization
  • Radiography has a role in the emergency assessment of the pregnant patient.
    • It is available quickly at most facilities, and emergency physicians are skilled at independent interpretation of radiographs.
    • If areas other than the pelvis require radiographic evaluation, shield the abdomen; perform abdominal radiography only when it is absolutely necessary.
    • Plain radiographs of the abdomen may be used for pelvimetry to show the position and number of fetuses.

More on Pregnancy, Delivery

Overview: Pregnancy, Delivery
Differential Diagnoses & Workup: Pregnancy, Delivery
Treatment & Medication: Pregnancy, Delivery
Follow-up: Pregnancy, Delivery
References
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References

  1. National Center for Health Statistics. Vital Stats Births. Available at http://www.cdc.gov/nchs/datawh/vitalstats/VitalStatsbirths.htm. Accessed April 11, 2008.

  2. CDC. Healthier mothers and babies. MMWR Morb Mortal Wkly Rep. Oct 1 1999;48(38):849-58. [Medline]. [Full Text].

  3. Frew S. MedLaw. Available at www.medlaw.com.

  4. [Guideline] ACOG Committee on Ethics. Innovative practice: Ethical Guidelines. [Full Text].

  5. Danforth DN. Obstetrics and Gynecology. 4th ed. Philadelphia, Pa: Harper and Row; 1982.

  6. Mifsud AJ, Efstratiou A, Charlett A. Early-onset neonatal group B streptococcal infection in London: 1990-1999. BJOG. Sep 2004;111(9):1006-11. [Medline].

  7. Willson JR. Atlas of Obstetric Technic. 2nd ed. St Louis, Mo: Mosby; 1969.

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Further Reading

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Keywords

labor and delivery, birth, labor, delivery in the ER, delivery in the ED, delivery of baby, vaginal delivery, vaginal birth, cesarean delivery, cesarean birth, C section, breech presentation

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Contributor Information and Disclosures

Author

Thomas E Benzoni, DO, Medical Director of Mercy Air Care; Consulting Staff, Department of Emergency Medicine, Mercy Medical Center; Member, Board of Directors, Iowa Medical Society
Thomas E Benzoni, DO is a member of the following medical societies: American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, American Osteopathic Association, and Iowa Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Assaad J Sayah, MD, Chief, Department of Emergency Medicine, Cambridge Health Alliance
Assaad J Sayah, MD is a member of the following medical societies: National Association of EMS Physicians
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Mark Zwanger, MD, MBA, Assistant Professor, Department of Emergency Medicine, Thomas Jefferson University
Mark Zwanger, MD, MBA is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and American Medical Association
Disclosure: Medicines Company Consulting fee Consulting; Pfizer Salary Employment

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Pamela L Dyne, MD, Professor of Clinical Medicine/Emergency Medicine, David Geffen School of Medicine at UCLA; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center
Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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