Labor and Delivery in the Emergency Department Workup

Updated: Jul 26, 2017
  • Author: Thomas E Benzoni, DO, MT(ASCP); Chief Editor: Mark A Clark, MD  more...
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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.)

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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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