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Immediate priorities
Maternal fetal stabilization
Airway breathing circulation stability
If hypotension, isotonic crystalloid bolus then reassessment
If shock, massive hemorrhage pathway consideration
Maternal vital signs
If fever, sepsis evaluation and antibiotics pathway
If severe hypertension, preeclampsia pathway
Fetal status
Continuous fetal heart rate monitoring if viable gestational age
If nonreassuring tracing, immediate obstetrics notification
Gestational age confirmation
If less than viability threshold per local policy, individualized goals of care
If 24 to 36 weeks 6 days, preterm labor pathway
Key decisions
Delivery versus delay decision points
Contraindications to delaying delivery
Intraamniotic infection suspicion
Placental abruption suspicion
Nonreassuring fetal status persistent
Severe preeclampsia or eclampsia
Significant maternal hemorrhage
Benefit of delay
Antenatal corticosteroid window completion
Maternal transfer to higher level neonatal care
Magnesium sulfate neuroprotection completion
Monitoring and access
Monitoring setup
Two large bore IV access if moderate to high risk
If ongoing bleeding, type and crossmatch
Urine output tracking
If magnesium infusion, hourly urine output target
Continuous pulse oximetry if respiratory risk
Initial therapeutics bundle
Time sensitive therapies
If gestational age 24 to 33 weeks 6 days and likely delivery within 7 days, antenatal corticosteroids
Betamethasone IM regimen
Dexamethasone IM regimen
If gestational age less than 32 weeks and likely delivery within 24 hours, magnesium sulfate neuroprotection
Loading dose then maintenance dose protocol
If tocolysis candidate and gestational age less than 34 weeks, short course tocolysis
Nifedipine protocol
Indomethacin protocol if early gestational age
If group B streptococcus status unknown and preterm labor with risk of delivery, intrapartum prophylaxis plan
Penicillin regimen
Allergy alternatives
PITFALLS
Common misses
Cervical exam before placenta location confirmation in bleeding patient
Ultrasound placenta assessment first if bleeding and unknown placenta location
Preterm labor mimic
Urinary tract infection
Dehydration
Abruption
Appendicitis
Under recognition of infection
Maternal fever absent in early intraamniotic infection
Uterine tenderness and fetal tachycardia as early clues
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.