One of the toughest challenges as an ob/gyn is trying to determine if a patient needs evaluation in the hospital or if it’s ok to wait out the situation and follow-up in clinic. Sometimes it’s pretty self-explanatory (see the cartoon above), but most of the time it’s not. Below are some of the symptoms that definitely merit a check in the hospital setting.
In early pregnancy, some of the biggest concerns for patients that may require evaluation are vaginal bleeding and lower abdominal pain. Occasional spotting or a small amount of blood with wiping may be normal, particularly after intercourse; however, heavy bleeding (soaking through more than a pad per hour) with or without passage of clots or tissue may indicate a miscarriage and usually requires an emergency workup. Unfortunately, our ability to intervene and save a pregnancy is pretty limited until the baby can survive outside of mom (around 23-24 weeks at the earliest), but it is important to determine if surgery is necessary to treat the bleeding. The same sort of evaluation may is also indicated in a woman who has lower abdominal or pelvic pain despite rest, hydration, change in position or extra strength Tylenol. If the pain goes away with any of those measures, it generally isn’t expected to have a negative effect on mom’s or baby’s health, but if the pain continues despite those interventions, the number one priority is confirming that the pregnancy is inside the uterus. Ectopic pregnancies (those outside the uterus) can’t result in delivery of a baby, but they may require surgical (or in some cases medical) intervention to prevent maternal heavy bleeding into the abdomen. Additionally, non-pregnancy emergencies may also present with worsening pain.
In addition to heavy bleeding and persistent pain, there are a few other considerations that require evaluation at the hospital later in pregnancy. I can’t count the number of calls I’ve had where someone asks me if she’s in labor, but no matter how many times I’m asked, I can’t know for sure unless a patient has an exam and is monitored over time. I have learned how to text finger emojis, but I still haven’t figured out how to do a cervical check over the phone ;) Generally, painful contractions every 5 minutes or so are a good indication of the onset of labor, although this may vary from person to person. Monitoring of the baby’s response to contractions as well as their frequency helps let us know how to manage your care. Even if you came to the office, you’d generally still require evaluation on labor and delivery for persistent contractions as your cervix may change over the course of a few hours. Besides, my staff would kill me if they had to clean up after a delivery in the office :O Other than labor checks, if there is concern your bag of water has broken, then you should go in for evaluation. This is important even if you aren’t having contractions because you may need medicine to augment labor. Even if your group B strep test was negative, if delivery is delayed for too long after your water breaks, you can still develop an infection in the uterus that can negatively affect the health of both mom and baby. Lastly, if you feel that your baby isn’t moving, and he/she hasn’t moved enough to be adequate according to the guidelines of your provider, then monitoring and testing of your baby is indicated, either in the office or on labor and delivery.
While the blog doesn’t cover every potential situation, this should be a helpful start on deciding whether or not to go in for evaluation. That being said, be sure to also pay attention to any other specific warnings given by your provider, as these may vary from patient to patient. Also, it is generally to err on the side of caution, so if you have a specific concern that’s not in this guide, either call your doctor or go in to have it checked out. Even if it’s frustrating to be sent home after everything checks out OK, it’s still better to be sent home than not to be seen for something that change the course of your care. That being said, the majority of pregnant women and their babies do very well, and even if you develop some of the above symptoms, it doesn’t necessarily mean your pregnancy won’t be successful. Good luck with your pregnancy, and let us know if we can be of help!
Dr Nick
In early pregnancy, some of the biggest concerns for patients that may require evaluation are vaginal bleeding and lower abdominal pain. Occasional spotting or a small amount of blood with wiping may be normal, particularly after intercourse; however, heavy bleeding (soaking through more than a pad per hour) with or without passage of clots or tissue may indicate a miscarriage and usually requires an emergency workup. Unfortunately, our ability to intervene and save a pregnancy is pretty limited until the baby can survive outside of mom (around 23-24 weeks at the earliest), but it is important to determine if surgery is necessary to treat the bleeding. The same sort of evaluation may is also indicated in a woman who has lower abdominal or pelvic pain despite rest, hydration, change in position or extra strength Tylenol. If the pain goes away with any of those measures, it generally isn’t expected to have a negative effect on mom’s or baby’s health, but if the pain continues despite those interventions, the number one priority is confirming that the pregnancy is inside the uterus. Ectopic pregnancies (those outside the uterus) can’t result in delivery of a baby, but they may require surgical (or in some cases medical) intervention to prevent maternal heavy bleeding into the abdomen. Additionally, non-pregnancy emergencies may also present with worsening pain.
In addition to heavy bleeding and persistent pain, there are a few other considerations that require evaluation at the hospital later in pregnancy. I can’t count the number of calls I’ve had where someone asks me if she’s in labor, but no matter how many times I’m asked, I can’t know for sure unless a patient has an exam and is monitored over time. I have learned how to text finger emojis, but I still haven’t figured out how to do a cervical check over the phone ;) Generally, painful contractions every 5 minutes or so are a good indication of the onset of labor, although this may vary from person to person. Monitoring of the baby’s response to contractions as well as their frequency helps let us know how to manage your care. Even if you came to the office, you’d generally still require evaluation on labor and delivery for persistent contractions as your cervix may change over the course of a few hours. Besides, my staff would kill me if they had to clean up after a delivery in the office :O Other than labor checks, if there is concern your bag of water has broken, then you should go in for evaluation. This is important even if you aren’t having contractions because you may need medicine to augment labor. Even if your group B strep test was negative, if delivery is delayed for too long after your water breaks, you can still develop an infection in the uterus that can negatively affect the health of both mom and baby. Lastly, if you feel that your baby isn’t moving, and he/she hasn’t moved enough to be adequate according to the guidelines of your provider, then monitoring and testing of your baby is indicated, either in the office or on labor and delivery.
While the blog doesn’t cover every potential situation, this should be a helpful start on deciding whether or not to go in for evaluation. That being said, be sure to also pay attention to any other specific warnings given by your provider, as these may vary from patient to patient. Also, it is generally to err on the side of caution, so if you have a specific concern that’s not in this guide, either call your doctor or go in to have it checked out. Even if it’s frustrating to be sent home after everything checks out OK, it’s still better to be sent home than not to be seen for something that change the course of your care. That being said, the majority of pregnant women and their babies do very well, and even if you develop some of the above symptoms, it doesn’t necessarily mean your pregnancy won’t be successful. Good luck with your pregnancy, and let us know if we can be of help!
Dr Nick
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