Vaginal Bleeding – Later Pregnancy

As Vanessa and I sit here waiting for baby two to arrive, it occurs to me that this area of medicine is really a black box for me, and partially of my own doing. You see most hospitals send women who are 20+ weeks pregnant directly to the obstetrics floor. This is good patient care, but not good for my education. So I generally only meet these women after car accidents, stubbed toes and anything else unrelated to their pregnancies.

And when women arrive who are in active labor I’m especially motivated to roll them through the ER straight to OB for three reasons. First, I’m not an Ob/Gyn. Second, there aren’t many ways to better gum up an ER. Third is selfish… Any ER delivery = two daggum charts and a thousand buttons! (The miracle of birth is a lot less miraculous in the ER.)
All that said, here are third trimester buzzwords:

Red Flags:

• Fevers
• Bleeding
• Sudden abdominal pain (abruption)
• Shortness of breath/chest pain
• Lightheaded/syncope/unconscious
• Hypertension
• Headache, vision changes, belly pain (preeclampsia)
• Seizures (eclampsia)
• Jaundice
• Vomiting/diarrhea/dehydration
• Painful urination or suspected kidney infection
• Direct abdominal injury
• Known placenta problem (placenta previa, vasa previa)
• Many preterm deliveries/miscarriages
• Uncontrolled diabetes
• Bleeding or clotting disorders
• Still smoking/drinking/injecting etc
• No prenatal care
• “Water broke” (ruptured membranes) esp if more than a day ago
• Preterm contractions
• Crowning, breech, partially/fully delivered already (obviously)
• “Oye!”
• (What’d I miss OBs?)

Happy Words

• “I can still feel the baby moving in there.”
• “The IV fluids from the medics made me feel way better.”
• “Tylenol solved my headache.”
• “My OB said to come in for a liter of saline, and she’ll see me in the office tomorrow.”

That last point is one of the reasons we started PreR. IV hydration solves an awful lot, but just isn’t so easy to find outside an ER. Ask your OB/midwife/doula where they’d send you for IV fluids after hours, or even during business hours.

If you land in an ER during your third trimester, expect a good size workup… because someone was worried enough to not send you along to the obstetrics floor. IV fluids, blood/urine tests, ultrasound and fetal monitoring are fairly standard.

Hopefully Vanessa and I will be able to bypass the ER very soon. If for some reason we deliver in the ER or the parking lot, I just won’t be able to look my unlucky colleague in the eye as they click through our two charts!

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