Presentations
21 pathways
Patients arrive with a symptom, not a diagnosis. Each pathway starts with the clinician's first question and ends with a differential that says what favours and what argues against every entry.
Obstetrics
- Bleeding in early pregnancyIs she stable, and where is the pregnancy?Is she stable, and where is the pregnancy?Emergency department or early pregnancy unit, under 20 weeks
- Bleeding in later pregnancyWhere is the placenta, and is anyone bleeding to death?Where is the placenta, and is anyone bleeding to death?OB triage, 20 weeks and beyond
- Abdominal pain in pregnancyWhat gestation, and is the pain obstetric or not?What gestation, and is the pain obstetric or not?OB triage or the emergency department, any gestation
- Headache or raised blood pressure after 20 weeksIs this preeclampsia, and how severe?Is this preeclampsia, and how severe?Clinic, triage or the ward
- Decreased fetal movementsIs the fetus alive and well right now, and why did movements fall?Is the fetus alive and well right now, and why did movements fall?Day assessment or triage, from 24 to 28 weeks onward
- Leaking fluid: rupture of membranesAre the membranes ruptured, and at what gestation?Are the membranes ruptured, and at what gestation?Triage, any gestation from viability
- Contractions before 37 weeksIs this preterm labour, and if it might be, what can be done in the next 48 hours?Is this preterm labour, and if it might be, what can be done in the next 48 hours?Triage, 22 to 36+6 weeks
- Fever after deliveryWhat day, what route of delivery, and where is the source?What day, what route of delivery, and where is the source?Postpartum ward or the emergency department in the six weeks after birth
- Nausea and vomiting in pregnancyIs this the nausea of pregnancy, and is she keeping enough down to stay hydrated?Is this the nausea of pregnancy, and is she keeping enough down to stay hydrated?Family practice, obstetric triage or the emergency department, usually before 16 weeks
- Itch in pregnancyIs there a rash, and are the bile acids raised?Is there a rash, and are the bile acids raised?Antenatal clinic or obstetric triage, usually the third trimester
Gynaecology
- Heavy menstrual bleedingIs she anaemic, and is the cause structural?Is she anaemic, and is the cause structural?Gynaecology or family practice clinic
- Acute pelvic painIs she pregnant, and could this be torsion?Is she pregnant, and could this be torsion?Emergency department
- Chronic pelvic painWhat pattern does the pain follow, and which systems are involved?What pattern does the pain follow, and which systems are involved?Gynaecology clinic
- Adnexal massIs it likely benign, and does it need surgery or surveillance?Is it likely benign, and does it need surgery or surveillance?Clinic, or an incidental finding
- Vaginal dischargeIs it physiological, vaginal, or cervical?Is it physiological, vaginal, or cervical?Clinic
- Postmenopausal bleedingIs this endometrial cancer, until proven otherwise?Is this endometrial cancer, until proven otherwise?Clinic, referred promptly
- Vulval itch, pain and skin changeIs this an infection, a skin disease, or a lesion that needs a biopsy?Is this an infection, a skin disease, or a lesion that needs a biopsy?Family practice or gynaecology clinic, at any age
- Urinary incontinence and prolapseIs the leak with urgency, with effort, or both, and is there something coming down?Is the leak with urgency, with effort, or both, and is there something coming down?Family practice or urogynaecology clinic
- Hot flushes, sleep and the years around the menopauseIs this the menopause, what is bothering her most, and is there a reason not to offer hormone therapy?Is this the menopause, what is bothering her most, and is there a reason not to offer hormone therapy?Family practice or menopause clinic, usually between 45 and 55