Evaluation

Primary maternal and fetal survey

Laboratory: blood type, Rh factor test, hematocrit measurement, Kleihauer-Betke test, coagulation studies

Consider obstetric ultrasonography

If greater than 20 weeks' gestation, monitor for contractions

If fewer than three contractions per hour, monitor for four hours, then discharge

If three to seven contractions per hour, monitor for 24 hours, then discharge

Discharge criteria

Resolution of contractions

Reassuring fetal heart tracing

Intact membranes

No vaginal bleeding

No uterine tenderness

All Rh-negative patients should receive Rh immune globulin therapy unless the injury is remote from the uterus (e.g., isolated distal extremity)12