Type and Screen, CBC, Chem 10, Coags, U/A with culture, Utox (cocaine increases risk of abruption)
Do NOT perform digital exam in patients who present with vaginal bleeding when >20 weeks pregnant due to potential for placenta previa
Start with ultrasound to assess position of cervix and rule out placenta previa
Swabs for nitrazine, fetal fibronectin (FFN), GBS culture should also precede digital exam
Some lubricants can affect FFN and amniotic fluid pH strip
Nitrazine test (5% FP rate, 1% FN rate) - pH swab turns blue, indicating alkalotic amniotic fluid (pH 6.5 - 7.5 positive test); do not touch to mucous plug in cervix
Proceed with digital exam if placental previa unlikely, and digital exam is urgently needed to assist patient care, such as in fetal HR decels
Some lubricants can affect FFN and amniotic fluid pH strip
Nitrazine test (5% FP rate, 1% FN rate) - pH swab turns blue, indicating alkalotic amniotic fluid (pH 6.5 - 7.5 positive test); do not touch to mucous plug in cervix
Preterm labor
Emergent delivery
Placenta previa
Placental abruption
Septic abortion
Vasa previa
Preeclampsia
Uterine rupture