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Unbooked woman in labour

No notes, no scans, no blood group. A common situation.

Source: Good practice

Quick work-up

  1. Ask: LMP, parity, previous CS, bleeding, fits, headache, fever, fetal movements.
  2. Check BP, pulse, temperature, urine protein, pallor.
  3. Abdominal exam: fundal height, lie, presentation, scars; fetal heart.
  4. Bedside scan if available: number of babies, presentation, placenta, liquor, heartbeat.
  5. Bloods: Hb, blood group and Rh, HBsAg, HCV, HIV, syphilis, glucose; crossmatch if anaemic or previous CS.
  6. Vaginal exam only after excluding placenta praevia.
  7. Treat severe anaemia, hypertension and infection; plan birth with a senior.
  8. Give anti-D if Rh-negative and baby Rh-positive.
Previous CS with unknown scar, severe anaemia or high BP: involve a senior early and keep blood ready.
A summary for trained clinicians. Always check the full guideline, the patient in front of you and your hospital's protocol. Spotted an error? Tell us.