Before Your First: L&D Triage Evaluation

Your first Labor & Delivery triage shift is coming up — here's how to handle it. In this episode, we walk through the full workflow: from chart-checking a patient before you walk in the room, to gathering a focused history, performing your exam, staffing efficiently, and writing a solid triage note. Topics Covered: Where to Start Chart check the patient — age, parity, gestational age, medical and OB problems. Confirm dating with your own eyes. Trust but verify. Skim prior encounters for chronic conditions and what's worked before. Check if they're up to date on routine OB care (e.g., GBS swab at 36 weeks). Start a note using premade templates to save time. Bring your ultrasound, stethoscope, mask, and something to keep notes. If the patient is on the NST, don't wait for it to complete before performing your sono. Gather a focused but detailed history, then do a focused physical exam. Perform a pelvic exam as indicated (with patient consent), with or without your chief. Most Common Chief Complaints Rule out labor / preterm labor, general abdominal pain Rule out PPROM / SROM Decreased fetal movement (DFM) Rule out PIH / preeclampsia Vaginal bleeding/spotting or abnormal discharge Urinary symptoms, nausea/vomiting, constipation, headaches, URI symptoms How to Staff Gather all data before staffing — evaluate the NST, review your slides, listen to lungs if needed. Follow the standard SOAP format: Age, parity, GA, chief complaint → HPI → vitals, PE (including SSE/SVE) → your plan. Think through: labs needed, ECG, formal sono, how long to monitor pressures, admission vs. discharge, and whether other services need to be consulted. Your plan doesn't need to be 100% right — that's what intern year is for. Track patterns so you can apply them next time. Closing the Loop with the Patient – Update them as things progress. If you don't know the answer, say so, then find out (UpToDate, Open Evidence, institutional resources, your chief/senior). Writing Your Triage Note – Thorough but concise. Think through the differential. Update the note as labs return and the plan is finalized. Use dictation or EMR AI tools. Have your chief review notes the first few weeks. After the Visit – Update the patient's problem list with any new diagnoses (e.g., pyelonephritis, gestational hypertension). About the Speakers: Host: Lucy Brown, MD, MPH – Resident physician at Johns Hopkins GYN/OB. Dr. Brown is passionate about medical and resident education and will be pursuing a Fellowship in Complex Family Planning after residency. Guest Speaker: Ore Afon, MD – Gyn/Ob resident at Johns Hopkins Hospital. She attended Cornell University for undergrad and graduated from the University of Toledo College of Medicine & Life Sciences. Intern Ready: Ob/Gyn is a podcast aimed at interns and off-service residents beginning their post-graduate training in Obstetrics and Gynecology. The views expressed are the speakers' own and do not constitute medical advice.