Clinical Case 2

A 28-year-old female presents to the ED with intermittent abdominal pains for the past 6 hours. She describes a brief episode of watery PV discharge and has passed a small volume of bloody-mucous PV.

Her medical history includes obesity, previous drug dependence (No IVDU), alcohol dependence and anxiety/depression. She is unaware of any active pregnancy (G3P2) but reports that she has been sexually active and that her last menstrual period was around 40 weeks ago. Her abdomen is distended and there is intermittent lower abdominal muscular contraction. You perform a urinalysis which is positive for HCG (No proteinuria). The patient reports that while in the toilet, she thought she could see “a head coming out” of her vagina. A brief, chaperoned, PV examination confirms that there is a crowning foetal head and active maternal contractions. 

How do you manage this patient from here? Consider the following: location within the ED, specialty teams you would like involved, initial assessment, investigations, and management of the impending birth (You do not need to cover the specific steps of delivery).