All EMS presentations
Obstetric/GynecologicClinical presentation

Pregnancy / labour

A streamlined, differential-led presentation for rapid clinical review.

Clinical snapshot

Twenty-second review

  • Labour results from coordinated uterine contractions and cervical change; pregnancy also alters circulating volume, oxygen demand, and risk for hemorrhage, hypertension, and thromboembolism.
  • Imminent birth, heavy bleeding, seizure, severe hypertension symptoms, cord prolapse, abnormal presentation, or maternal shock requires immediate escalation.
  • Keep false labour or non-obstetric abdominal pain in the differential; overlapping or concurrent illness remains possible.
  • For pregnancy / labour, trends and combinations of findings are more informative than one isolated vital sign.
Differentials

Compare the clinical patterns

The repeated material is grouped inside each possibility. Open only the condition you need.

Serious4 conditions
EclampsiaTime-sensitive high-risk possibility

HPI

Clarify gestational age, gravida/para, due date; contraction frequency/duration; membranes ruptured - when/fluid colour.

Signs & symptoms

Seizure, severe pain, bleeding, shock, or visible cord.

Focused exam

Assess abdominal tenderness, fundal height or contractions when appropriate, visible bleeding, perineal findings only when necessary, and maternal perfusion; Preserve privacy and use a chaperone or support person when possible.

Brief pathophysiology

Eclampsia may cause pregnancy / labour through a time-sensitive process capable of rapid physiological deterioration.

Vital-sign pattern

What the trend may show

Possible pattern

Normal pregnancy changes baseline physiology. Use gestational context and trend; marked abnormalities, hypoxemia, or hypotension are not explained by uncomplicated pregnancy.

Heart rate (bpm)

Modestly higher baseline

Maternal heart rate commonly increases during pregnancy.

Blood pressure (mmHg)

Often normal / slightly lower

Blood pressure may fall modestly mid-pregnancy and rises toward baseline near term.

Respiratory rate (breaths/min)

Usually near baseline

Minute ventilation rises mainly through tidal volume rather than a large respiratory-rate increase.

Oxygen saturation (SpO₂)

Usually normal

Low saturation requires evaluation for respiratory or thromboembolic disease.

Front-load in the triage report

  • Eclampsia: Seizure, severe pain, bleeding, shock, or visible cord.
  • Gestational age, gravida/para, due date.
  • Contraction frequency/duration.
AbruptionTime-sensitive high-risk possibility

HPI

Clarify contraction frequency/duration; membranes ruptured - when/fluid colour; bleeding.

Signs & symptoms

Seizure, severe pain, bleeding, shock, or visible cord.

Focused exam

Preserve privacy and use a chaperone or support person when possible; Determine gestation and contractions; assess bleeding, membrane rupture, urge to push, crowning only when necessary, fetal movement, and maternal perfusion.

Brief pathophysiology

Abruption may cause pregnancy / labour through a time-sensitive process capable of rapid physiological deterioration.

Vital-sign pattern

What the trend may show

Possible pattern

Pregnancy can preserve blood pressure despite significant blood loss. Trend heart rate, pressure, perfusion, and respiratory rate; compare with gestational baseline.

Heart rate (bpm)

Often rises

Maternal tachycardia is a common compensatory sign, but pregnancy baseline is higher.

Blood pressure (mmHg)

May fall late

Hypotension is a concerning and potentially late sign of blood loss.

MAP (mmHg)

May fall

A declining MAP supports worsening perfusion.

Respiratory rate (breaths/min)

May rise

Tachypnea can accompany shock, pain, or anxiety.

Front-load in the triage report

  • Abruption: Seizure, severe pain, bleeding, shock, or visible cord.
  • Contraction frequency/duration.
  • Membranes ruptured - when/fluid colour.
PreviaTime-sensitive high-risk possibility

HPI

Clarify membranes ruptured - when/fluid colour; bleeding; urge to push/crowning.

Signs & symptoms

Seizure, severe pain, bleeding, shock, or visible cord.

Focused exam

Preserve privacy and use a chaperone or support person when possible; Determine gestation and contractions; assess bleeding, membrane rupture, urge to push, crowning only when necessary, fetal movement, and maternal perfusion.

Brief pathophysiology

Previa may cause pregnancy / labour through a time-sensitive process capable of rapid physiological deterioration.

Vital-sign pattern

What the trend may show

Possible pattern

Normal pregnancy changes baseline physiology. Use gestational context and trend; marked abnormalities, hypoxemia, or hypotension are not explained by uncomplicated pregnancy.

Heart rate (bpm)

Modestly higher baseline

Maternal heart rate commonly increases during pregnancy.

Blood pressure (mmHg)

Often normal / slightly lower

Blood pressure may fall modestly mid-pregnancy and rises toward baseline near term.

Respiratory rate (breaths/min)

Usually near baseline

Minute ventilation rises mainly through tidal volume rather than a large respiratory-rate increase.

Oxygen saturation (SpO₂)

Usually normal

Low saturation requires evaluation for respiratory or thromboembolic disease.

Front-load in the triage report

  • Previa: Seizure, severe pain, bleeding, shock, or visible cord.
  • Membranes ruptured - when/fluid colour.
  • Bleeding.
Cord prolapseTime-sensitive high-risk possibility

HPI

Clarify bleeding; urge to push/crowning; prior rapid delivery.

Signs & symptoms

Seizure, severe pain, bleeding, shock, or visible cord.

Focused exam

Preserve privacy and use a chaperone or support person when possible; Determine gestation and contractions; assess bleeding, membrane rupture, urge to push, crowning only when necessary, fetal movement, and maternal perfusion.

Brief pathophysiology

Cord prolapse may cause pregnancy / labour through a time-sensitive process capable of rapid physiological deterioration.

Vital-sign pattern

What the trend may show

Possible pattern

Normal pregnancy changes baseline physiology. Use gestational context and trend; marked abnormalities, hypoxemia, or hypotension are not explained by uncomplicated pregnancy.

Heart rate (bpm)

Modestly higher baseline

Maternal heart rate commonly increases during pregnancy.

Blood pressure (mmHg)

Often normal / slightly lower

Blood pressure may fall modestly mid-pregnancy and rises toward baseline near term.

Respiratory rate (breaths/min)

Usually near baseline

Minute ventilation rises mainly through tidal volume rather than a large respiratory-rate increase.

Oxygen saturation (SpO₂)

Usually normal

Low saturation requires evaluation for respiratory or thromboembolic disease.

Front-load in the triage report

  • Cord prolapse: Seizure, severe pain, bleeding, shock, or visible cord.
  • Bleeding.
  • Urge to push/crowning.
Common1 condition
Normal labourCommon presentation pattern

HPI

Clarify gestational age, gravida/para, due date; contraction frequency/duration; membranes ruptured - when/fluid colour.

Signs & symptoms

Regular progressive contractions, cervical pressure, and rupture of membranes may indicate progression.

Focused exam

Assess abdominal tenderness, fundal height or contractions when appropriate, visible bleeding, perineal findings only when necessary, and maternal perfusion; Preserve privacy and use a chaperone or support person when possible.

Brief pathophysiology

Normal labour may explain the presenting symptoms through a common clinical mechanism, while serial assessment checks for complications or an alternate cause.

Vital-sign pattern

What the trend may show

Possible pattern

Normal pregnancy changes baseline physiology. Use gestational context and trend; marked abnormalities, hypoxemia, or hypotension are not explained by uncomplicated pregnancy.

Heart rate (bpm)

Modestly higher baseline

Maternal heart rate commonly increases during pregnancy.

Blood pressure (mmHg)

Often normal / slightly lower

Blood pressure may fall modestly mid-pregnancy and rises toward baseline near term.

Respiratory rate (breaths/min)

Usually near baseline

Minute ventilation rises mainly through tidal volume rather than a large respiratory-rate increase.

Oxygen saturation (SpO₂)

Usually normal

Low saturation requires evaluation for respiratory or thromboembolic disease.

Front-load in the triage report

  • Regular progressive contractions, cervical pressure, and rupture of membranes may indicate progression.
  • Gestational age, gravida/para, due date.
  • Contraction frequency/duration.
Mimics2 conditions
False labourImportant alternative presentation

HPI

Clarify gestational age, gravida/para, due date; contraction frequency/duration; membranes ruptured - when/fluid colour.

Signs & symptoms

Irregular contractions or alternative focal findings may mimic labour.

Focused exam

Assess abdominal tenderness, fundal height or contractions when appropriate, visible bleeding, perineal findings only when necessary, and maternal perfusion; Preserve privacy and use a chaperone or support person when possible.

Brief pathophysiology

False labour can resemble pregnancy / labour through overlapping symptoms or referred physiology despite a different primary mechanism.

Vital-sign pattern

What the trend may show

Possible pattern

Normal pregnancy changes baseline physiology. Use gestational context and trend; marked abnormalities, hypoxemia, or hypotension are not explained by uncomplicated pregnancy.

Heart rate (bpm)

Modestly higher baseline

Maternal heart rate commonly increases during pregnancy.

Blood pressure (mmHg)

Often normal / slightly lower

Blood pressure may fall modestly mid-pregnancy and rises toward baseline near term.

Respiratory rate (breaths/min)

Usually near baseline

Minute ventilation rises mainly through tidal volume rather than a large respiratory-rate increase.

Oxygen saturation (SpO₂)

Usually normal

Low saturation requires evaluation for respiratory or thromboembolic disease.

Front-load in the triage report

  • Irregular contractions or alternative focal findings may mimic labour.
  • Gestational age, gravida/para, due date.
  • Contraction frequency/duration.
Non-obstetric abdominal painImportant alternative presentation

HPI

Clarify contraction frequency/duration; membranes ruptured - when/fluid colour; bleeding.

Signs & symptoms

Irregular contractions or alternative focal findings may mimic labour.

Focused exam

Preserve privacy and use a chaperone or support person when possible; Determine gestation and contractions; assess bleeding, membrane rupture, urge to push, crowning only when necessary, fetal movement, and maternal perfusion.

Brief pathophysiology

Non-obstetric abdominal pain can resemble pregnancy / labour through overlapping symptoms or referred physiology despite a different primary mechanism.

Vital-sign pattern

What the trend may show

Possible pattern

Normal pregnancy changes baseline physiology. Use gestational context and trend; marked abnormalities, hypoxemia, or hypotension are not explained by uncomplicated pregnancy.

Heart rate (bpm)

Modestly higher baseline

Maternal heart rate commonly increases during pregnancy.

Blood pressure (mmHg)

Often normal / slightly lower

Blood pressure may fall modestly mid-pregnancy and rises toward baseline near term.

Respiratory rate (breaths/min)

Usually near baseline

Minute ventilation rises mainly through tidal volume rather than a large respiratory-rate increase.

Oxygen saturation (SpO₂)

Usually normal

Low saturation requires evaluation for respiratory or thromboembolic disease.

Front-load in the triage report

  • Irregular contractions or alternative focal findings may mimic labour.
  • Contraction frequency/duration.
  • Membranes ruptured - when/fluid colour.
Red flags

Findings that should escalate concern

  • Imminent birth, heavy bleeding, seizure, severe hypertension symptoms, cord prolapse, abnormal presentation, or maternal shock requires immediate escalation.
  • Eclampsia, abruption, previa, or cord prolapse: Seizure, severe pain, bleeding, shock, or visible cord.
Related medications

Medication recognition

ApixabanRivaroxabanClopidogrelWarfarin
Related EMS presentations

Continue the clinical pathway

GIAbdominal painObstetric/GynecologicVaginal bleeding / gynecologic emergencyObstetric/GynecologicPostpartum complicationObstetric/GynecologicEarly-pregnancy pain / bleedingPediatricNewborn concern
References

Clinical and academic sources

Curated clinical guidance and peer-reviewed evidence supporting this presentation. Current BCEHS guidance, medical direction, and local policy remain authoritative for practice.

BCEHS Handbook — specific CPGs

  1. L01: Maternity (General)BC Emergency Health Services Handbook

    Official BCEHS clinical practice guidance for maternity (general).

  2. L02: Normal Labour and DeliveryBC Emergency Health Services Handbook

    Official BCEHS clinical practice guidance for normal labour and delivery.

Supporting clinical and academic evidence

  1. Practice Bulletin No. 193: Tubal Ectopic PregnancyAmerican College of Obstetricians and Gynecologists

    Evidence-based diagnosis and management guidance for tubal ectopic pregnancy.

  2. CEDIS Presenting Complaint List updateCanadian Association of Emergency Physicians

    Presenting-complaint terminology and categorization context. It does not establish a prehospital “top 100” ranking.

  3. Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhageWorld Health Organization

    Current evidence-based guidance for recognition and management of postpartum hemorrhage in healthcare settings.

  4. Uterotonic Drugs in Prehospital Deliveries: A Systematic ReviewHealthcare · 2025

    Prehospital birth and postpartum-hemorrhage evidence, with emphasis on maternal bleeding risk and escalation.