Labor and Delivery in the Emergency Department Workup

  • Author: Thomas E Benzoni, DO; Chief Editor: Mark A Clark, MD   more...
 
Updated: May 3, 2011
 

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.)
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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.
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Contributor Information and Disclosures
Author

Thomas E Benzoni, DO  Medical Director of Mercy Air Care; Attending Staff, Department of Emergency Medicine, Mercy Medical Center; Member, Board of Directors, Iowa Medical Society; Medical Director, DMAT-B; Medical Manager, IA TF-1 USAR.

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.

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Mark Zwanger, MD, MBA  Assistant Professor, Department of Emergency Medicine, Jefferson Medical College of 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: Nothing to disclose.

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

Mark A Clark, MD  Assistant Clinical Professor of Medicine, Columbia University College of Physicians and Surgeons; Program Director, Emergency Medicine Residency, St Luke's/Roosevelt Hospital Center

Mark A Clark, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

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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