OB Special Circumstances - Revision history

LiamG: /* Still Birth */

2023-07-20T01:10:56Z

Still Birth

← Older revision		Revision as of 01:10, 20 July 2023
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	===Still Birth===		===Still Birth===
	Notify HROB. The mother should be allowed time as she desires with her baby for the grieving process.		Notify HROB. The mother should be allowed time as she desires with her baby for the grieving process.
	* see [[media:~~Expected_Death_Protocol~~.pdf\|YKHC Clinical Protocol: Unexpected Death Protocol (page #2)]]		* see [[media:Death.pdf\|YKHC Clinical Protocol: Unexpected Death Protocol (page #3)]]

	===Labor in the Village===		===Labor in the Village===

LiamG: /* Fetal Demise */

2023-07-20T01:10:27Z

Fetal Demise

← Older revision		Revision as of 01:10, 20 July 2023
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	* Placental fetal tissue for genetic testing; maternal blood for CMP, PTT, cardio-lipid ab, Kleihauer-Betke, lupus anticoag, beta 2 glucoprotein, bile acids, and fibrinogen; and urine for UDS.		* Placental fetal tissue for genetic testing; maternal blood for CMP, PTT, cardio-lipid ab, Kleihauer-Betke, lupus anticoag, beta 2 glucoprotein, bile acids, and fibrinogen; and urine for UDS.
	* Finally, a “Certificate of Fetal Death” needs to be completed for >20 week fetuses and sent to HIS		* Finally, a “Certificate of Fetal Death” needs to be completed for >20 week fetuses and sent to HIS
	* see [[media:~~Expected_Death_Protocol~~.pdf\|YKHC Clinical Protocol: Unexpected Death Protocol (page #2)]]		* see [[media:Death.pdf\|YKHC Clinical Protocol: Unexpected Death Protocol (page #3)]]

	===Still Birth===		===Still Birth===

JenniferH: /* Fetal Demise */

2022-07-05T18:11:48Z

Fetal Demise

← Older revision		Revision as of 18:11, 5 July 2022
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	* Placental fetal tissue for genetic testing; maternal blood for CMP, PTT, cardio-lipid ab, Kleihauer-Betke, lupus anticoag, beta 2 glucoprotein, bile acids, and fibrinogen; and urine for UDS.		* Placental fetal tissue for genetic testing; maternal blood for CMP, PTT, cardio-lipid ab, Kleihauer-Betke, lupus anticoag, beta 2 glucoprotein, bile acids, and fibrinogen; and urine for UDS.
	* Finally, a “Certificate of Fetal Death” needs to be completed for >20 week fetuses and sent to HIS		* Finally, a “Certificate of Fetal Death” needs to be completed for >20 week fetuses and sent to HIS
	* see [[media:Expected_Death_Protocol.pdf\|YKHC Clinical Protocol: Death Protocol]]		* see [[media:Expected_Death_Protocol.pdf\|YKHC Clinical Protocol: Unexpected Death Protocol (page #2)]]

	===Still Birth===		===Still Birth===

JenniferH: /* Still Birth */

2022-07-05T18:11:21Z

Still Birth

← Older revision		Revision as of 18:11, 5 July 2022
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	===Still Birth===		===Still Birth===
	Notify HROB. The mother should be allowed time as she desires with her baby for the grieving process.		Notify HROB. The mother should be allowed time as she desires with her baby for the grieving process.
			* see [[media:Expected_Death_Protocol.pdf\|YKHC Clinical Protocol: Unexpected Death Protocol (page #2)]]

	===Labor in the Village===		===Labor in the Village===
	[[media:Village OB Patient in Possible Labor.pdf\|Village OB Patient in Possible Labor]]		[[media:Village OB Patient in Possible Labor.pdf\|Village OB Patient in Possible Labor]]

JenniferH: /* Fetal Demise */

2022-07-05T18:10:40Z

Fetal Demise

← Older revision		Revision as of 18:10, 5 July 2022
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	Consult with HROB.		Consult with HROB.

	~~There is no YKHC Guideline or Policy for this at present.~~
	* Generally treat this situation as “an induction,” confirm IUFD status with US, including vertex position. No need to assess Bishop score. Only use Cytotec.		* Generally treat this situation as “an induction,” confirm IUFD status with US, including vertex position. No need to assess Bishop score. Only use Cytotec.
	* Delay Cytotec induction by at least 24 hrs (up to 3-4 ds) to allow grief process to proceed-there is no rush to induce if membranes are intact.		* Delay Cytotec induction by at least 24 hrs (up to 3-4 ds) to allow grief process to proceed-there is no rush to induce if membranes are intact.
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	* Placental fetal tissue for genetic testing; maternal blood for CMP, PTT, cardio-lipid ab, Kleihauer-Betke, lupus anticoag, beta 2 glucoprotein, bile acids, and fibrinogen; and urine for UDS.		* Placental fetal tissue for genetic testing; maternal blood for CMP, PTT, cardio-lipid ab, Kleihauer-Betke, lupus anticoag, beta 2 glucoprotein, bile acids, and fibrinogen; and urine for UDS.
	* Finally, a “Certificate of Fetal Death” needs to be completed for >20 week fetuses and sent to HIS		* Finally, a “Certificate of Fetal Death” needs to be completed for >20 week fetuses and sent to HIS
			* see [[media:Expected_Death_Protocol.pdf\|YKHC Clinical Protocol: Death Protocol]]

	===Still Birth===		===Still Birth===
	Notify HROB. The mother should be allowed time as she desires with her baby for the grieving process.		Notify HROB. The mother should be allowed time as she desires with her baby for the grieving process.

JenniferH: /* GBS Positive (or unknown) */

2021-08-16T19:52:28Z

GBS Positive (or unknown)

← Older revision		Revision as of 19:52, 16 August 2021
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	These guidelines are reflected in the standing OB admission orders and involve treating this infection usually during the active labor period and hopefully prior to vaginal delivery to reduce neonatal morbidity/mortality. Four hours is the minimal treatment time regardless of the antibiotic used (but presumes second dose of PCN onboard). If that standard is not met, no septic evaluation for the newborn is required but a 48 hour admission is recommended.		These guidelines are reflected in the standing OB admission orders and involve treating this infection usually during the active labor period and hopefully prior to vaginal delivery to reduce neonatal morbidity/mortality. Four hours is the minimal treatment time regardless of the antibiotic used (but presumes second dose of PCN onboard). If that standard is not met, no septic evaluation for the newborn is required but a 48 hour admission is recommended.

			For women with limited prenatal care or presenting in preterm labor, we can now do [[Group B Strep (GBS) PCR or Xpert GBS]] for a presumptive screening of GBS status; if positive, will be confirmed with a routine GBS screen.

	===Retained Placenta===		===Retained Placenta===

JenniferH at 08:15, 21 November 2020

2020-11-21T08:15:01Z

← Older revision		Revision as of 08:15, 21 November 2020
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	The above also applies to a HIGH RISK term patient who is not in Bethel (as per signed agreement) but is having contractions or is SROM. A LOW RISK patient is this situation would deliver in the village (usually by the CHA or mid-level) also per a signed agreement. If there is no signed agreement, then legally the patient may need to be medevaced.		The above also applies to a HIGH RISK term patient who is not in Bethel (as per signed agreement) but is having contractions or is SROM. A LOW RISK patient is this situation would deliver in the village (usually by the CHA or mid-level) also per a signed agreement. If there is no signed agreement, then legally the patient may need to be medevaced.

	[[~~category~~:OB & Newborn]]
			[[:Category:OB & Newborn\|OB & Newborn Main Page]]

JenniferH: /* Postpartum Hemorrhage (PPH) (high incidence) */

2020-10-21T23:20:27Z

Postpartum Hemorrhage (PPH) (high incidence)

← Older revision		Revision as of 23:20, 21 October 2020
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	===Retained Placenta===		===Retained Placenta===
	Allow at least 30 minutes prior to making this determination. The “active management of the third stage of labor” (see ALSO) can reduce this occurrence. Manual extraction of the placenta with appropriate analgesia may be required.		Allow at least 30 minutes prior to making this determination. The “active management of the third stage of labor” (see ALSO) can reduce this occurrence. Manual extraction of the placenta with appropriate analgesia may be required.
	===Postpartum Hemorrhage (PPH) (high incidence)===		===[[Postpartum Hemorrhage (PPH)]] (high incidence)===
	For those patients at high risk for this (includes AMA and prior history of PPH), a few extra hemostatic agents (such as Pitocin/methergine [if BP not elevated]/Cytotec/Hemabate) should be in the delivery room (see ALSO [[Guidelines]]).		For those patients at high risk for this (includes AMA and prior history of PPH), a few extra hemostatic agents (such as Pitocin/methergine [if BP not elevated]/Cytotec/Hemabate) should be in the delivery room (see ALSO [[Guidelines]]).

	===Pre-eclampsia (PEC)===		===Pre-eclampsia (PEC)===
	Induce as able at EGA 38 weeks or arrange transfer to ANMC prior to 39 weeks. Also see PEC section above under “OB Triage Patients.” A new PEC and Induction Policy exists for this situation and is kept in the “Induction Book” in the NWing Doc’s Office (YKHC Clinical Guidelines for PEC and Induction are out-of-date <2011>). The best treatment for PEC is delivery of the baby. Vigilance is key to prevent the sometimes fatal progression of PEC to eclampsia up to 48 hours or more postpartum.		Induce as able at EGA 38 weeks or arrange transfer to ANMC prior to 39 weeks. Also see PEC section above under “OB Triage Patients.” A new PEC and Induction Policy exists for this situation and is kept in the “Induction Book” in the NWing Doc’s Office (YKHC Clinical Guidelines for PEC and Induction are out-of-date <2011>). The best treatment for PEC is delivery of the baby. Vigilance is key to prevent the sometimes fatal progression of PEC to eclampsia up to 48 hours or more postpartum.

JenniferH: /* Intrahepatic Cholestasis of Pregnancy (IHCP) */

2020-03-31T00:54:07Z

Intrahepatic Cholestasis of Pregnancy (IHCP)

← Older revision		Revision as of 00:54, 31 March 2020
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	Induce as able at EGA 38 weeks or arrange transfer to ANMC prior to 39 weeks. Also see PEC section above under “OB Triage Patients.” A new PEC and Induction Policy exists for this situation and is kept in the “Induction Book” in the NWing Doc’s Office (YKHC Clinical Guidelines for PEC and Induction are out-of-date <2011>). The best treatment for PEC is delivery of the baby. Vigilance is key to prevent the sometimes fatal progression of PEC to eclampsia up to 48 hours or more postpartum.		Induce as able at EGA 38 weeks or arrange transfer to ANMC prior to 39 weeks. Also see PEC section above under “OB Triage Patients.” A new PEC and Induction Policy exists for this situation and is kept in the “Induction Book” in the NWing Doc’s Office (YKHC Clinical Guidelines for PEC and Induction are out-of-date <2011>). The best treatment for PEC is delivery of the baby. Vigilance is key to prevent the sometimes fatal progression of PEC to eclampsia up to 48 hours or more postpartum.
	===Intrahepatic Cholestasis of Pregnancy (IHCP)===		===Intrahepatic Cholestasis of Pregnancy (IHCP)===
	[[~~Intrahepatic Cholestatis of Pregnancy (~~IHCP)\|See YKHC Clinical ~~Guidelines~~]]		[[media:IHCP.pdf\|See YKHC Clinical Guideline for IHCP]]
	This is very common here. In addition to the guideline there is an Induction Policy kept in the “Induction Book” in the NWing Doc’s Office. IHCP can result in a bad newborn outcome and may need to be treated with induction at 37 weeks at ANMC We can do an induction in Bethel at 38 weeks as indicated.		This is very common here. In addition to the guideline there is an Induction Policy kept in the “Induction Book” in the NWing Doc’s Office. IHCP can result in a bad newborn outcome and may need to be treated with induction at 37 weeks at ANMC We can do an induction in Bethel at 38 weeks as indicated.

JenniferH: /* GBS Positive (or unknown) */

2020-03-31T00:37:42Z

GBS Positive (or unknown)

← Older revision		Revision as of 00:37, 31 March 2020
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	===GBS Positive (or unknown)===		===GBS Positive (or unknown)===
	[[~~Group B Streptococcus (GBS) – Maternal~~\|See YKHC Clinical Guideline]]		[[media:GBS_maternal.pdf\|See YKHC Clinical Guideline for Maternal GBS Screening]]

	These guidelines are reflected in the standing OB admission orders and involve treating this infection usually during the active labor period and hopefully prior to vaginal delivery to reduce neonatal morbidity/mortality. Four hours is the minimal treatment time regardless of the antibiotic used (but presumes second dose of PCN onboard). If that standard is not met, no septic evaluation for the newborn is required but a 48 hour admission is recommended.		These guidelines are reflected in the standing OB admission orders and involve treating this infection usually during the active labor period and hopefully prior to vaginal delivery to reduce neonatal morbidity/mortality. Four hours is the minimal treatment time regardless of the antibiotic used (but presumes second dose of PCN onboard). If that standard is not met, no septic evaluation for the newborn is required but a 48 hour admission is recommended.