LiamG at 01:08, 21 April 2026

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LiamG at 03:27, 29 January 2026

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LiamG at 18:47, 31 July 2025

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Mfaubion at 20:10, 21 July 2015

2015-07-21T20:10:30Z

← Older revision		Revision as of 20:10, 21 July 2015
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	* _ VBAC Consent signed?		* _ VBAC Consent signed?

	:category:Women's Health		[[:category:Women's Health]]

Mfaubion at 20:09, 21 July 2015

2015-07-21T20:09:56Z

← Older revision		Revision as of 20:09, 21 July 2015
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	* On admission in labor: CBC, Type and Screen. Admitting physician will notify: OR team on call, HRO B on call.		* On admission in labor: CBC, Type and Screen. Admitting physician will notify: OR team on call, HRO B on call.
	* _ VBAC Consent signed?		* _ VBAC Consent signed?

			:category:Women's Health

Mfaubion: Created page with "'''ABNORMAL QUAD (TETRA) SCREEN FOR __________''' * Obtain level II (dafus) ultrasound, refer for perinatology and genetic counseling. '''ADRENO-GENITAL SYNDROME, previous ch..."

2015-07-21T20:08:58Z

Created page with "'''ABNORMAL QUAD (TETRA) SCREEN FOR __________''' * Obtain level II (dafus) ultrasound, refer for perinatology and genetic counseling. '''ADRENO-GENITAL SYNDROME, previous ch..."

New page

'''ABNORMAL QUAD (TETRA) SCREEN FOR __________'''
* Obtain level II (dafus) ultrasound, refer for perinatology and genetic counseling.

'''ADRENO-GENITAL SYNDROME, previous child'''
* Immediately, start Dexamethasone 20mcg/Kg pre-pregnancy weight divided TID
* At 10 weeks, draw maternal blood for fetal sex, Contact lab for Harmony Prenatal DNA testing
* If male, stop Dexamethasone and refer to Perinatologist for DAFUS and consult
* If female, continue Dexamethasone and refer to Perinatologist for DAFUS, amniocentesis and consult

'''ADVANCE MATERNAL AGE'''
* Offer 2nd trimester Tetra screen
* Recommend Level II (DAFUS) Ultrasound and Genetic Counseling

'''ALLERGY TO PENICILLIN'''
* If GBS positive, send the GBS culture for sensitivity to clindamycin and erythromycin.

'''ANEMIA, SEVERE'''
* Draw anemia in pregnancy panel
* Treat vitamin deficiency
* Refer to HROB if hemoglobinopathy
* Follow Anemia in pregnancy guideline

'''ASYMPTOMATIC BACTURIA'''
* Urine culture 1st prenatal
* TOC date_____
* Urinalysis with reflex by clean catch every visit
* Treat any level of bacteria

'''CARDIAC ANANOMALIES, current pregnancy'''
* If suspected anomaly found during screening ultrasound in Bethel, refer to ANMC for DAFUS and fetal echocardiogram.
* Return to HROB meeting after the ANMC visit to discuss and plan for subsequent care.

'''CHRONIC HEPATITIS B VIRUS (HBV) INFECTION'''
* HBSAg positive
* Draw Liver Enzymes, HBV DNA
* If HBV DNA positive, refer to Hepatology for possible anti-viral therapy
* ALL neonates born to mother with a positive HBSAg WILL receive HBIG and HBV vaccine at birth.

'''CHRONIC HYPERTENSION'''
* Consult HROB on call at 1st prenatal visit
* Baseline testing: 24 hour urine protein, comprehensive panel, EKG at first visit
* Stop Medication at first visit and recheck BP in 1 week
* Aspirin 81mg daily weeks 12 to 36
* Ultrasound for growth weeks 24, 28, 32, 36
* Start antenatal testing at 34 weeks, NST, AFI weekly
* Repeat labs for suspected Gestational Hypertension
* Consult obstetrician at 38 weeks for delivery plan

'''CONGENITAL ADRENAL HYPERPLASIA, previous child'''
* Immediately, start Dexamethasone 20mcg/Kg pre-pregnancy weight divided TID
* At 10 weeks, draw maternal blood for fetal sex, Contact lab for Harmony Prenatal DNA testing
* If male, stop Dexamethasone and refer to Perinatologist for DAFUS and consult
* If female, continue Dexamethasone and refer to Perinatologist for DAFUS, amniocentesis and consult

'''DIABETES, PRE-PREGNANCY'''
* Consult Obstetrician for medication
* Recommend split dose NPH/Regular insulin
* Baseline testing: 24 hour urine protein, comprehensive panel, EKG, TSH
* Optometry referral
* Consider 1st Trimester screening for aneuploidy
* Refer for Level II (DAFUS), Fetal Echo and Perinatologist
* Transfer of Care at 30 weeks to Anchorage

'''DILATED FETAL RENAL PELVIS'''
* Ultrasound at 32 weeks or as directed by consultant
* If > 8mm, notify pediatrician after delivery
* If < 8mm, take no action, this is normal.

'''ELEVATED MSAFP'''
* OBTAIN LEVEL II (DAFUS) ULTRASOUND, REFER FOR PERINATOLOGY AND GENETIC COUNSELING
* Watch for: IUGR, PREECLAMPSIA, PRETERM LABOR, VAGINAL BLEEDING
* ULTRASOUND AT 32 WEEKS or as directed consultant

'''FETAL GROWTH RESTRICTION, Suspected'''
* Obtain an US for fetal Growth
* If US shows EFW<10% send to Anchorage for US and Perinatology consultation.
* Follow Plan per Perinatology consultation

'''GENITAL HERPES'''
* Inspection of vulva and vagina at 36 weeks and in labor
* Encourage acyclovir 400mg three times daily for prophylaxis at 36 weeks or 4 weeks before delivery

'''GESTATIONAL DIABETES'''
* Goal: Fasting <95, 2 hour PP <120
* Close monitoring until controlled (weekly visits or contact)
* If poor control, review at HROB and stay in Bethel after 32 weeks
* If on medication, stay in Bethel at 32 weeks.
* NST 2x and AFI weekly if medication or poor control after 32 weeks.

'''GESTATIONAL PRURITIS – ITCHING WITHOUT LAB ABNORMALITIES'''
* Do not start Ursodiol
* Repeat Bile Acids and LFT every 2 weeks.
* BPP weekly starting at 32 weeks.

'''GRAND MULTIPARA (5 or more deliveries)'''
* Type & Screen on admission in labor
* Active management of 3rd Stage recommended
* Discuss Birth Control Plans at 36 weeks
* Sign Sterilization consent at 20 week visit

'''GROUP B STREP BACTURIA in current pregnancy'''
* Any level of GBS in the urine at any time of the pregnancy initiates this plan
* Do not do screen at 36 weeks.
* Begin prophylaxis in labor per protocol.

'''GROUP B STEP, PREVIOUS PREGNANCY WITH CULTURE AT TERM, BUT BABY WITH NO INFECTION'''
* No treatment is indicated
* Screen at 35-37 weeks per routine protocol.

'''GROUP B STEP, PREVIOUS BABY WITH INVASIVE DISEASE'''
* Screen for bacteria per the routine.
* Do Not screen at 35-37 weeks.
* Treat in Labor per protocol.

'''HISTORY OF DOMESTIC VIOLENCE'''
* Discuss at every visit.
* Monitor for signs or symptoms of abuse
* Offer counseling or referral for services.

'''HISTORY OF DEPRESSION/POST PARTUM DEPRESSION'''
* Screen every visit for depression
* Contact Impact for score >9
* Consider SSRI post partum

'''HISTORY OF INTRAHEPATIC CHOLESTATIS '''
* Draw baseline bile acids and liver enzymes at first visit
* Monitor for symptoms at every visit
* If severe clinical symptoms, redraw labs above and begin ursodiol 15 mg/kg divided BID.
* See guideline

'''HISTORY OF MOLAR PREGNANCY'''
* Make sure first trimester US has history of Molar pregnancy as a diagnosis
* Review the US with HROB physician
* Refer patient to HROB meeting
* Send Placenta for pathology after delivery.

'''HISTORY OF PREECLAMPSIA'''
* Consider baseline labs: 24 hour urine protein, CBC, PIH panel
* Monitor for signs or symptoms of preeclampsia and repeat labs as needed

'''HIGH RISK FOR PRETERM BIRTH'''
* Reason __________
* Recommend Progesterone 200mg vaginally daily 16 – 36 weeks
* HROB meeting discussion or consult obstetrician
* BIB date __________
* CCUA with reflex every visit
* Cervical length at 20-24 weeks
* Treat BV if symptomatic

'''HISTORY OF POST PARTUM HEMORRHAGE'''
* Type & Screen on admission in labor
* Second IV in labor
* Active management of 3rd Stage recommended

'''HISTORY OF SEIZURE DISORDER'''
* Begin Folic Acid 4gm daily ASAP
* Draw Drug level for current medication
* Consult HROB for possible medication change
* Level II (DAFUS) US at 18-22 weeks in Anchorage
* Monitor symptoms and drug levels as needed
* Monitor drug levels Postpartum as physiology changes

'''HISTORY OF SKELETAL DYSPLASIA OR DWARFISM'''
* If this occurs in any pregnancy, refer for genetic counseling.
* If counseling states there is a recurrence risk, refer to ANMC Perinatology at 1st Prenatal Visit.
* Refer all patients for DAFUS and consultation at ANMC
* Follow plan from ANMC Perinatology note

'''HISTORY OF SUBSTANCE ABUSE'''
* Discuss at EVERY visit
* Monitor for signs or symptoms of abuse
* Social services referral
* Urine drug screening recommended frequently

'''HISTORY OF PREECLAMPSIA with SEVERE FEATURES/ECLAMPSIA'''
* Aspirin 81mg daily from 12 to 36 weeks.
* Baseline labs: Protein/Creatinine ratio, CBC, PIH panel
* Monitor for signs or symptoms of preeclampsia and repeat labs as needed

'''HISTORY OF STILLBIRTH'''
* At first prenatal, attempt to locate the post stillbirth workup in the chart and document the results in your note for HROB conference.
* Add Total and fractionated Bile Acids to the 1st OB visit labs.
* Ultrasound for growth at 24, 28, 32 and 36 weeks.
* Visits every 2 weeks in Bethel after 28 weeks.
* Fetal Kick counts after 28 weeks
* Further planning after HROB meeting based on other diagnoses and risk factors. See ACOG Practice Bulletin 102 Management of Stillbirth

'''HYPERTHYROID prior to pregnancy'''
* Draw TSH, Free T4 and Total T4 at first visit and at least each Trimester.
* If s/p ablation on replacement, consider increasing dose by 25%.
* If on Methimazole, change to PTU for first trimester.
* If on PTU, continue at present dose.
* Switch to Methimazole as directed by ANMC consultants.
* Monitor for signs and symptoms of hyperthyroid disease at every visit.

'''HYPERTHYROID new diagnosis'''
* Draw TSH, Free T4 and Total T4 at first visit and at least each Trimester.
* Observe carefully for signs and symptoms of Thyroid storm.
* Avoid anti-thyroid medication in 1st trimester if possible.
* If tachycardic, start Atenolol 25mg daily
* Begin PTU at 50mg po TID, draw labs weekly until stable.
* Monitor for signs and symptoms of hyperthyroid disease at every visit.

'''HYPOTHYROID prior to pregnancy'''
* Consider increase of 25% in medication
* Order TSH, Free T4 and Total T4 every trimester

'''HYPOTHYROID new diagnosis'''
* Begin levothyroxine ASAP
* Check TSH; free T4 monthly until dosage stable
* Check TSH, free T4 every trimester thereafter
* Re-evaluate postpartum

'''INTRAHEPATIC CHOLESTASIS – Severe itching and abnormal Labs'''
* Start ursodiol 15 mg/kg divided BID
* Start weekly BPP at 32 weeks
* Redraw Bile Acids and LFTs weekly after 32 weeks
* May return home with weekly visits
* Consult HROB meeting or obstetrician
* Severe IHCP if Total BA >40, must be induced by 37 weeks.
* Send to Anchorage by 37 weeks

'''IUGR see Fetal Growth Restriction'''

'''Obesity'''
* If BMI >40, refer to HROB for consultation.
* If BMI >40 and patient 36 weeks gestation or later, Consult HROB on call and on call anesthesia
* Obtain US for growth at 28, 32 and 36 weeks.

'''POSITIVE ANTIBODY SCREEN'''
* Confirm antibody identification
* Contact Obstetrician or discuss at HROB ASAP
* Order Father of Baby Antigen test for the identified antigen
* Monthly antibody titers of the identified antibody
* If antibody titer increases by 2 dilutions, refer to Perinatologist for Plan

'''POSITIVE HIV SCREEN'''
* Confirm HIV status with HIV rapid test and Western Blot
* Order labs: CD4 Count, HIV genotype, HIV 1 RNA (Viral Load), CMP, CBC, LFT, Toxoplasm IgG, CMV IgG, RPR, HCV AB, GC/CT, PPD or Quantiferon.
* Refer to Early Intervention and Perinatology at ANMC.

'''PREECLAMPSIA in current pregnancy'''
* Prenatal visits weekly
* Weekly Labs CBC, AST, ALT, Uric Acid, Creatinine, BUN, protein/Creatinine ratio and 24 hour urine as needed
* NST 2x/week, AFI weekly
* US OB follow-up for growth every 3 weeks
* If Growth restriction suspected, refer to ANMC ASAP
* Consult with HROB at EVERY VISIT
* Refer to North Wing Physician for delivery at 38 weeks for delivery

'''PREVIOUS CESAREAN'''
* If considering repeat cesarean in Bethel, appointment with obstetrician ASAP
* Refer to HROB meeting for discussion
* Elects TOL at ANMC, _____
* Elects TOL at Bethel, _____
* Elects Cesarean ANMC, Bethel, _____
* TOL consent signed

'''RH NEGATIVE'''
* Repeat Type and Screen with Rhogam work up at 28 weeks.
* If RH negative, Give Rhogam at 28 weeks.
* At delivery, follow OB policy for Rh negative patients.

'''RUBELLA NON-IMMUNE'''
* Repeat Rubella vaccine postpartum if the patient has fewer than 2 immunizations ever

'''TWIN GESTATION '''
16-18 Weeks'''
* TV sono for cervical length
* Check largest vertical pocket of fluid for each twin
* Discuss risks of twin pregnancy (PTD, PEC, PPH/anemia, mal-presentation, C/S)
22 Weeks
* Prenatal check in Bethel – all checks after this must be in Bethel
* Complete/Anatomy US
24 Weeks
* Ultrasound for discordance-consider TV sono for Cervical length
* 1 hr GST, CBC, start FeSO4 BID
26 Weeks
* Prenatal visit
28 Weeks
* Ultrasound for discordance and TV sono for cervical length
30 Weeks
* BE IN BETHEL due to high risk pregnancy **
31 Weeks
* Prenatal check
32 Weeks
* Transfer to ANMC until delivery**

'''UTI IN PREGNANCY'''
* Urine Culture each trimester
* qhs prophylaxis after 2nd UTI or 1st pyelonephritis
* Results: 1st _____ 2nd _____ 3rd _____'

'''VBAC in Bethel, Planned'''
* Discuss Case at HROB meeting
* At BIB, provider will contact the HROB on call
* HROB on call will contact: Blood Bank lead, OB charge nurse, OR charge nurse.
* On admission in labor: CBC, Type and Screen. Admitting physician will notify: OR team on call, HRO B on call.
* _ VBAC Consent signed?

HROB Stickers--Problems/Plans - Revision history

LiamG at 01:08, 21 April 2026

LiamG at 03:27, 29 January 2026

LiamG at 18:47, 31 July 2025

Mfaubion at 20:10, 21 July 2015

Mfaubion at 20:09, 21 July 2015

Mfaubion: Created page with "'''ABNORMAL QUAD (TETRA) SCREEN FOR __________''' * Obtain level II (dafus) ultrasound, refer for perinatology and genetic counseling. '''ADRENO-GENITAL SYNDROME, previous ch..."