I wanted to share a GOOD CATCH from last night with Ashley Massey; the department was quite full with 27 patients in the waiting room when a 21-year-old woman checked in for back pain and urinary frequency. The patient was instructed on urine, and due to the volume, waited about 2 hours to be bedded. She had denied abdominal pain, nausea, vomiting, etc. and stated she didn't think she could be pregnant. Upon being bedded, the patient immediately went to the bathroom and was reminded that we needed a urine sample. The patient provided the sample, and when Ashley was in the room, she noticed the patient's "back pain" was quite low and was becoming rhythmic. The patient got up to use the bathroom again and Ashley noticed some blood on the bed, which the patient stated was new. Ashley got the doc, who ordered an abdominal/pelvic CT and came to do a bedside u/s to look for a kidney stone. Ashley was assisting the pt on the toilet and noted a large blood clot in the patient's vagina and asked about her periods, which the pt reported were usually very "hit or miss". U/S showed a fetus of at least 20 weeks and an OB2 was immediately activated and the patient taken upstairs at approximately 1215-1230. At 0128 the patient spontaneously delivered a 6#13oz baby girl, originally estimated to be 35 weeks, but later determined to be 39.6 weeks gestation. Baby's apgars were reassuring, but she was kept in NICU overnight for observation as there was some meconium-stained fluid and mom was thought to be GD. Ashley did a great job of grabbing the doctor and escalating the situation as soon as she felt things were changing, which ultimately got the patient to the appropriate level of care quickly, preventing issues to the patient or the baby.