INDEX

OBGYN Patients

Pregnant Patients

Pregnant in UED:

  •  In general, if a patient is 16 weeks or greater, she is transferred to the MEU after having an “ED Medical Screen” note with or without FHTs checked.

    • Exceptions to this rule can be found below.

  • If there is question about if a patient should be transferred, call the OB resident in the MEU (5-6105) or the L&D residents (4-4277).

Post Partum in UED:

  • A patient may be transferred to the MEU up to 2 weeks post-partum if there is a clear OB-related complaint (wound complications, hemorrhage, eclampsia).

Major Trauma or Critically Ill Pregnant Patients:

  • Consult OB immediately upon arrival or in anticipation of arrival

  • >23 wks – continuous fetal monitoring during UED treatment based on individualized recommendations from OB. Call L&D upon arrival.

  • >16 wks – spot check / monitor by L&D team, but no continuous monitoring necessary.

  • <16 wks – May perform an ED bedside US to assess fetal cardiac activity, but otherwise focus on treating the mom.

Acute Psychiatric Complaint (Psychosis, SI/HI):

  • Remain in UED for PES evaluation, treatment, and disposition unless in active labor or there’s a primary OB emergency.

Substance Abuse & Addiction:

  • If stable and beyond 16 wks pregnant, transfer to MEU for OB/Addiction Recovery collaboration.

  • If life threatening withdrawal or unstable vital signs, treat in UED with OB and Addiction recovery consults.

Stillbirth:

  • If a stillbirth occurs in the UED, once the patient is stable, the UED ANM should call MEU ANM to coordinate movement to MEU for counseling and bereavement resources.

 

Imminent Deliveries

UED Protocol:

  1. Activate Vocera badge and say “Urgent Broadcast to ED Delivery Team”.

    • Provide location and gestational age.

    • For backup: dial 5-1234 and say “Call L&D Shift Leader” and say “Please activate an imminent delivery in the UED Room ____.”

  2. The delivery supplies are located in a tall tan locked shelf in the resuscitation room.

    • The lock combination is 4277.

    • The delivery kits are on the top shelf.

OB-DeliveryKit.png
 

Gyn-Onc Patients

There is an ongoing effort to reduce unnecessary imaging and expedite consults for Gyn-Onc patients. Please see the protocol below.

 

Vaginal Bleeding & Transfusions

  • If active vaginal bleeding requiring transfusion, the patient should be admitted to OBGYN. If vaginal bleeding has stopped but patient still needs a transfusion, consult OBGYN and discuss disposition.

 

Follow-Up

Suggested follow-up timeframes for various OBGYN-related issues:

KEYWORDS: OBGYN, GYN, pregnancy, pregnant, miscarriage, MEU