OB Deliveries - Revision history

JenniferH: /* Pre-term Delivery */

2020-11-21T09:26:22Z

Pre-term Delivery

← Older revision		Revision as of 09:26, 21 November 2020
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	See [[media:Preterm_labor.pdf\|Preterm Labor (Screening, Prevention, Evaluation, and Treatment)]] and [[media:PPROM.pdf\|Preterm Premature Rupture of Membranes (PPROM) YKHC Clinical Guidelines]]		See [[media:Preterm_labor.pdf\|Preterm Labor (Screening, Prevention, Evaluation, and Treatment)]] and [[media:PPROM.pdf\|Preterm Premature Rupture of Membranes (PPROM) YKHC Clinical Guidelines]]

	See [[OB Triage Patients]] for preterm triage situations. Transfer to ANMC in consultation with ANMC OB on-call should be considered. Peds as well needs to be aware of this potential situation early on.		See [[OB Triage Patients]] for preterm triage situations.

			Transfer to ANMC in consultation with ANMC OB on-call should be considered. Peds as well needs to be aware of this potential situation early on.

	==Failure to Progress==		==Failure to Progress==

JenniferH: /* VBAC */

2020-11-21T09:26:00Z

VBAC

← Older revision		Revision as of 09:26, 21 November 2020
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	This is a HROB decision when the baby needs an urgent/emergent delivery. Other indications might be prevention of a birth canal disease exposure or birth canal trauma for a very early imminent preterm delivery or a higher risk prior C-section in Bethel in labor. There are situations when a scheduled C-sections can be done. When a planned Bethel VBAC is done, a C-section is always possible.		This is a HROB decision when the baby needs an urgent/emergent delivery. Other indications might be prevention of a birth canal disease exposure or birth canal trauma for a very early imminent preterm delivery or a higher risk prior C-section in Bethel in labor. There are situations when a scheduled C-sections can be done. When a planned Bethel VBAC is done, a C-section is always possible.
	==VBAC==		==VBAC==
	[[~~See~~ YKHC Clinical ~~Guidelines~~]].		See [[media:VBAC.pdf\|Vaginal Birth After Cesarian (VBAC) YKHC Clinical Guideline]].

	These deliveries are screened for the most LOW RISK situations. As mentioned above for VBAC OB Triage patients, anything less than a Category 1 fetal heart strip will require HROB presence in-house.		These deliveries are screened for the most LOW RISK situations. As mentioned above for VBAC OB Triage patients, anything less than a Category 1 fetal heart strip will require HROB presence in-house.

	==Postpartum Care==		==Postpartum Care==
	There are standing postpartum orders plus nursing protocols that cover the basic needs of postpartum care. A discussion about birth control can also be beneficial during this time. If a village term newborn cannot be discharged at the usual 48 hours (usually due to late preterm status or an elevated “high-intermediate” bilirubin level by Bili-Tool), the mother can still be discharged at 36-48 hours (but room-in with the newborn). Mom will follow up in Bethel for postpartum visit at 6weeks. Before discharge, update both mom and baby’s problem list – newborn, EGA, weight, etc.		There are standing postpartum orders plus nursing protocols that cover the basic needs of postpartum care. A discussion about birth control can also be beneficial during this time. If a village term newborn cannot be discharged at the usual 48 hours (usually due to late preterm status or an elevated “high-intermediate” bilirubin level by Bili-Tool), the mother can still be discharged at 36-48 hours (but room-in with the newborn). Mom will follow up in Bethel for postpartum visit at 6weeks. Before discharge, update both mom and baby’s problem list – newborn, EGA, weight, etc.

JenniferH: /* Induction */

2020-11-21T09:25:07Z

Induction

← Older revision		Revision as of 09:25, 21 November 2020
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	If meconium is noted ‘peds on call’ should be at the delivery for possible meconium aspiration. Hospitalist physicians should be familiar with the meconium aspiration procedure and set up. They should also be familiar with the newborn bag, mask, and suction equipment available in case the pediatrician cannot make it in in time for the initial resuscitation. If meconium is not noted until delivery, have peds paged STAT, and be prepared to aspirate meconium if the baby does not cry at delivery.		If meconium is noted ‘peds on call’ should be at the delivery for possible meconium aspiration. Hospitalist physicians should be familiar with the meconium aspiration procedure and set up. They should also be familiar with the newborn bag, mask, and suction equipment available in case the pediatrician cannot make it in in time for the initial resuscitation. If meconium is not noted until delivery, have peds paged STAT, and be prepared to aspirate meconium if the baby does not cry at delivery.
	==Induction==		==Induction==
	See Induction Policy in the NWing Doc’s Office in the “Induction Book" or the [[media:Induction_of_labor.pdf\|Induction of Labor]] YKHC Clinical Guideline.		See Induction Policy in the NWing Doc’s Office in the “Induction Book" or the [[media:Induction_of_labor.pdf\|Induction of Labor YKHC Clinical Guideline]].

	==Episiotomy==		==Episiotomy==

JenniferH: /* Induction */

2020-11-21T09:24:48Z

Induction

← Older revision		Revision as of 09:24, 21 November 2020
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	If meconium is noted ‘peds on call’ should be at the delivery for possible meconium aspiration. Hospitalist physicians should be familiar with the meconium aspiration procedure and set up. They should also be familiar with the newborn bag, mask, and suction equipment available in case the pediatrician cannot make it in in time for the initial resuscitation. If meconium is not noted until delivery, have peds paged STAT, and be prepared to aspirate meconium if the baby does not cry at delivery.		If meconium is noted ‘peds on call’ should be at the delivery for possible meconium aspiration. Hospitalist physicians should be familiar with the meconium aspiration procedure and set up. They should also be familiar with the newborn bag, mask, and suction equipment available in case the pediatrician cannot make it in in time for the initial resuscitation. If meconium is not noted until delivery, have peds paged STAT, and be prepared to aspirate meconium if the baby does not cry at delivery.
	==Induction==		==Induction==
	See ~~new~~ Induction Policy in the NWing Doc’s Office in the “Induction Book.~~” The current~~ YKHC Clinical ~~Guidelines (2011) are not current on this matter~~.		See Induction Policy in the NWing Doc’s Office in the “Induction Book" or the [[media:Induction_of_labor.pdf\|Induction of Labor]] YKHC Clinical Guideline.

	==Episiotomy==		==Episiotomy==
	This is discouraged and is usually unnecessary unless an urgent delivery is required as in Shoulder Dystocia or for a forceps delivery usually involving fetal distress.		This is discouraged and is usually unnecessary unless an urgent delivery is required as in Shoulder Dystocia or for a forceps delivery usually involving fetal distress.

JenniferH: /* Pre-term Delivery */

2020-11-21T09:22:54Z

Pre-term Delivery

← Older revision		Revision as of 09:22, 21 November 2020
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	See [[media:Preterm_labor.pdf\|Preterm Labor (Screening, Prevention, Evaluation, and Treatment)]] and [[media:PPROM.pdf\|Preterm Premature Rupture of Membranes (PPROM) YKHC Clinical Guidelines]]		See [[media:Preterm_labor.pdf\|Preterm Labor (Screening, Prevention, Evaluation, and Treatment)]] and [[media:PPROM.pdf\|Preterm Premature Rupture of Membranes (PPROM) YKHC Clinical Guidelines]]

	See preterm triage situations ~~above~~. Transfer to ANMC in consultation with ANMC OB on-call should be considered. Peds as well needs to be aware of this potential situation early on.		See [[OB Triage Patients]] for preterm triage situations. Transfer to ANMC in consultation with ANMC OB on-call should be considered. Peds as well needs to be aware of this potential situation early on.

	==Failure to Progress==		==Failure to Progress==

JenniferH: /* Pre-term Delivery */

2020-11-21T09:21:54Z

Pre-term Delivery

← Older revision		Revision as of 09:21, 21 November 2020
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	==Pre-term Delivery==		==Pre-term Delivery==
	See [[media:Preterm_labor.pdf\|Preterm Labor (Screening, Prevention, Evaluation, and Treatment) YKHC Clinical ~~Guideline~~]]		See [[media:Preterm_labor.pdf\|Preterm Labor (Screening, Prevention, Evaluation, and Treatment)]] and [[media:PPROM.pdf\|Preterm Premature Rupture of Membranes (PPROM) YKHC Clinical Guidelines]]

	See preterm triage situations above. Transfer to ANMC in consultation with ANMC OB on-call should be considered. Peds as well needs to be aware of this potential situation early on.		See preterm triage situations above. Transfer to ANMC in consultation with ANMC OB on-call should be considered. Peds as well needs to be aware of this potential situation early on.

JenniferH: /* Pre-term Delivery */

2020-11-21T09:19:44Z

Pre-term Delivery

← Older revision		Revision as of 09:19, 21 November 2020
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	==Pre-term Delivery==		==Pre-term Delivery==
	[[~~See~~ YKHC Clinical ~~Guidelines~~]]		See [[media:Preterm_labor.pdf\|Preterm Labor (Screening, Prevention, Evaluation, and Treatment) YKHC Clinical Guideline]]
	See preterm triage situations above. Transfer to ANMC in consultation with ANMC OB on-call should be considered. Peds as well needs to be aware of this potential situation early on.		See preterm triage situations above. Transfer to ANMC in consultation with ANMC OB on-call should be considered. Peds as well needs to be aware of this potential situation early on.

	==Failure to Progress==		==Failure to Progress==
	This requires evaluation for CPD, LGA, poor contractions and other etiologies in consultation with HROB and may result in a trial of pitocin augmentation with internal monitors. Depending on the assessment, a C-section is a possibility.		This requires evaluation for CPD, LGA, poor contractions and other etiologies in consultation with HROB and may result in a trial of pitocin augmentation with internal monitors. Depending on the assessment, a C-section is a possibility.

JenniferH: /* Routine Vaginal */

2020-11-21T09:18:51Z

Routine Vaginal

← Older revision		Revision as of 09:18, 21 November 2020
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	==Routine Vaginal==		==Routine Vaginal==
	~~[[See YKHC Clinical Guidelines]]~~
	This should be the norm as it presents in the form of Primigravida or Multiparous. Anything that might be High Risk (and not planned to be managed in Bethel) during prenatal care should have already been screened out and sent to Anchorage.		This should be the norm as it presents in the form of Primigravida or Multiparous. Anything that might be High Risk (and not planned to be managed in Bethel) during prenatal care should have already been screened out and sent to Anchorage.

	==Pre-term Delivery==		==Pre-term Delivery==
	[[See YKHC Clinical Guidelines]]		[[See YKHC Clinical Guidelines]]

JenniferH at 08:14, 21 November 2020

2020-11-21T08:14:37Z

← Older revision		Revision as of 08:14, 21 November 2020
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	==Postpartum Care==		==Postpartum Care==
	There are standing postpartum orders plus nursing protocols that cover the basic needs of postpartum care. A discussion about birth control can also be beneficial during this time. If a village term newborn cannot be discharged at the usual 48 hours (usually due to late preterm status or an elevated “high-intermediate” bilirubin level by Bili-Tool), the mother can still be discharged at 36-48 hours (but room-in with the newborn). Mom will follow up in Bethel for postpartum visit at 6weeks. Before discharge, update both mom and baby’s problem list – newborn, EGA, weight, etc.		There are standing postpartum orders plus nursing protocols that cover the basic needs of postpartum care. A discussion about birth control can also be beneficial during this time. If a village term newborn cannot be discharged at the usual 48 hours (usually due to late preterm status or an elevated “high-intermediate” bilirubin level by Bili-Tool), the mother can still be discharged at 36-48 hours (but room-in with the newborn). Mom will follow up in Bethel for postpartum visit at 6weeks. Before discharge, update both mom and baby’s problem list – newborn, EGA, weight, etc.


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

JenniferH: /* Postpartum Care */

2020-11-21T08:14:13Z

Postpartum Care

← Older revision		Revision as of 08:14, 21 November 2020
Line 22:		Line 22:
	==Postpartum Care==		==Postpartum Care==
	There are standing postpartum orders plus nursing protocols that cover the basic needs of postpartum care. A discussion about birth control can also be beneficial during this time. If a village term newborn cannot be discharged at the usual 48 hours (usually due to late preterm status or an elevated “high-intermediate” bilirubin level by Bili-Tool), the mother can still be discharged at 36-48 hours (but room-in with the newborn). Mom will follow up in Bethel for postpartum visit at 6weeks. Before discharge, update both mom and baby’s problem list – newborn, EGA, weight, etc.		There are standing postpartum orders plus nursing protocols that cover the basic needs of postpartum care. A discussion about birth control can also be beneficial during this time. If a village term newborn cannot be discharged at the usual 48 hours (usually due to late preterm status or an elevated “high-intermediate” bilirubin level by Bili-Tool), the mother can still be discharged at 36-48 hours (but room-in with the newborn). Mom will follow up in Bethel for postpartum visit at 6weeks. Before discharge, update both mom and baby’s problem list – newborn, EGA, weight, etc.

	~~[[category:OB & Newborn]]~~