OB Triage Patients - Revision history

JenniferH: /* Antepartum Care */

2020-11-21T09:18:08Z

Antepartum Care

← Older revision		Revision as of 09:18, 21 November 2020
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	These patients are seen in the prenatal clinic unless it is after hours. Any missing labs or other tests (e.g. PPD) can be done in OB Triage. If needed, an OB US can be ordered for the following Monday-Friday morning.		These patients are seen in the prenatal clinic unless it is after hours. Any missing labs or other tests (e.g. PPD) can be done in OB Triage. If needed, an OB US can be ordered for the following Monday-Friday morning.
	===Antepartum Care===		===Antepartum Care (see [[Prenatal Information\|Prenatal Information YKHC Wiki Page]])===
	This is best done in the village and/or Bethel clinic and follows a specific schedule of tests and evaluations (always assessing for HIGH RISK situations) at any point during pregnancy.		This is best done in the village and/or Bethel clinic and follows a specific schedule of tests and evaluations (always assessing for HIGH RISK situations) at any point during pregnancy.


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

JenniferH: /* Antepartum Care */

2020-11-21T09:16:40Z

Antepartum Care

← Older revision		Revision as of 09:16, 21 November 2020
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	These patients are seen in the prenatal clinic unless it is after hours. Any missing labs or other tests (e.g. PPD) can be done in OB Triage. If needed, an OB US can be ordered for the following Monday-Friday morning.		These patients are seen in the prenatal clinic unless it is after hours. Any missing labs or other tests (e.g. PPD) can be done in OB Triage. If needed, an OB US can be ordered for the following Monday-Friday morning.
	===Antepartum Care===		===Antepartum Care===
	This is best done in the village and/or Bethel clinic and follows a specific schedule of tests and evaluations (always assessing for HIGH RISK situations) at any point ~~durin~~		This is best done in the village and/or Bethel clinic and follows a specific schedule of tests and evaluations (always assessing for HIGH RISK situations) at any point during pregnancy.


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

JenniferH: /* Preterm contractions and/or labor: */

2020-11-21T09:14:41Z

Preterm contractions and/or labor:

← Older revision		Revision as of 09:14, 21 November 2020
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	===Preterm contractions and/or labor:===		===Preterm contractions and/or labor:===
	[[Preterm Labor ~~— Bethel\|See~~ YKHC Clinical ~~Guidelines~~]]		See [[media:Preterm_labor.pdf\|Preterm Labor (Screening, Prevention, Evaluation, and Treatment) YKHC Clinical Guideline]]

	This is an urgent OB Triage situation. Patients (EGA <36 weeks) with contractions (>4/min) should be actively treated to stop while searching for their cause, keeping in mind that tocolysis in general should be reserved for gestational ages 24-34 weeks and fetal fibronectin can only be used in 24-34 weeks. If contractions resolve, fetal fibronectin (see YKHC Clinical Guidelines-p24) can be employed to give reassurance especially prior to allowing this patient to return home to her village if prior to BIB (Be-In-Bethel) date (or 30 days prior to EDC). If uterine contractions do not stop and especially if labor is present, discussion of a preterm delivery verses transfer to Anchorage should occur with HROB with Peds alerted. If later in the day and you want an ultrasound (after contractions have stopped), keep patient overnight at prematernal home and order an ultrasound for the following morning.		This is an urgent OB Triage situation. Patients (EGA <36 weeks) with contractions (>4/min) should be actively treated to stop while searching for their cause, keeping in mind that tocolysis in general should be reserved for gestational ages 24-34 weeks and fetal fibronectin can only be used in 24-34 weeks. If contractions resolve, fetal fibronectin (see YKHC Clinical Guidelines-p24) can be employed to give reassurance especially prior to allowing this patient to return home to her village if prior to BIB (Be-In-Bethel) date (or 30 days prior to EDC). If uterine contractions do not stop and especially if labor is present, discussion of a preterm delivery verses transfer to Anchorage should occur with HROB with Peds alerted. If later in the day and you want an ultrasound (after contractions have stopped), keep patient overnight at prematernal home and order an ultrasound for the following morning.

JenniferH: /* VBAC (vaginal birth after C-section) patient in active labor: */

2020-11-21T09:13:46Z

VBAC (vaginal birth after C-section) patient in active labor:

← Older revision		Revision as of 09:13, 21 November 2020
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	===VBAC (vaginal birth after C-section) patient in active labor:===		===VBAC (vaginal birth after C-section) patient in active labor:===
	See [[media:VBAC.pdf\|Vaginal Birth After Cesarian (VBAC)\|Vaginal Birth After Cesarean (VBAC) YKHC Clinical Guideline]]		See [[media:VBAC.pdf\|Vaginal Birth After Cesarian (VBAC)\|Vaginal Birth After Cesarean (VBAC) YKHC Clinical Guideline]]

	These pre-screened low risk patients are appropriate for labor management on OB. If any fetal heart tracing other than a Category 1 is appreciated, the HROB consultant must be in-house (It should be stated that properly screened VBAC patients have a lower maternal mortality rate than the average prenatal active labor patient).		These pre-screened low risk patients are appropriate for labor management on OB. If any fetal heart tracing other than a Category 1 is appreciated, the HROB consultant must be in-house (It should be stated that properly screened VBAC patients have a lower maternal mortality rate than the average prenatal active labor patient).

JenniferH: /* VBAC (vaginal birth after C-section) patient in active labor: */

2020-11-21T09:12:37Z

VBAC (vaginal birth after C-section) patient in active labor:

← Older revision		Revision as of 09:12, 21 November 2020
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	===VBAC (vaginal birth after C-section) patient in active labor:===		===VBAC (vaginal birth after C-section) patient in active labor:===
	[[Vaginal Birth After Cesarean (VBAC)~~\|See~~ YKHC Clinical ~~Guidelines~~]]		See [[media:VBAC.pdf\|Vaginal Birth After Cesarian (VBAC)\|Vaginal Birth After Cesarean (VBAC) YKHC Clinical Guideline]]

	These pre-screened low risk patients are appropriate for labor management on OB. If any fetal heart tracing other than a Category 1 is appreciated, the HROB consultant must be in-house (It should be stated that properly screened VBAC patients have a lower maternal mortality rate than the average prenatal active labor patient).		These pre-screened low risk patients are appropriate for labor management on OB. If any fetal heart tracing other than a Category 1 is appreciated, the HROB consultant must be in-house (It should be stated that properly screened VBAC patients have a lower maternal mortality rate than the average prenatal active labor patient).

JenniferH: /* Active term labor-multiparous: */

2020-11-21T09:11:00Z

Active term labor-multiparous:

← Older revision		Revision as of 09:11, 21 November 2020
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	===Active term labor-multiparous:===		===Active term labor-multiparous:===
	~~[[See YKHC Clinical Guidelines]]~~
	Same as above with labor progression generally faster. If this patient has had a previous C-section and is not in Anchorage already, a C-section will be considered (a VABC might also be considered with HROB consultation).		Same as above with labor progression generally faster. If this patient has had a previous C-section and is not in Anchorage already, a C-section will be considered (a VABC might also be considered with HROB consultation).

	===VBAC (vaginal birth after C-section) patient in active labor:===		===VBAC (vaginal birth after C-section) patient in active labor:===
	[[Vaginal Birth After Cesarean (VBAC)\|See YKHC Clinical Guidelines]]		[[Vaginal Birth After Cesarean (VBAC)\|See YKHC Clinical Guidelines]]

JenniferH: /* Active term labor-primigravida: */

2020-11-21T09:10:37Z

Active term labor-primigravida:

← Older revision		Revision as of 09:10, 21 November 2020
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	==Common OB Triage Scenarios==		==Common OB Triage Scenarios==
	===Active term labor-primigravida:===		===Active term labor-primigravida:===
	~~[[See YKHC Clinical Guidelines]]~~
	On presentation, all aspects of the prenatal history are reviewed and confirmed (especially for gestational RISK FACTORS). Prenatal dating is important and how dates were confirmed can usually be found on the problem list. If it’s not there already, please add it after reviewing first prenatal ultrasound and LMP. Also review media manager to see if a patient has had OB care at ANMC – the OB notes can usually be found there. Any prenatal tests lacking at this time can then be ordered. Active labor is assessed by cervical change over time and is especially important in the patient with an unproven pelvis.		On presentation, all aspects of the prenatal history are reviewed and confirmed (especially for gestational RISK FACTORS). Prenatal dating is important and how dates were confirmed can usually be found on the problem list. If it’s not there already, please add it after reviewing first prenatal ultrasound and LMP. Also review media manager to see if a patient has had OB care at ANMC – the OB notes can usually be found there. Any prenatal tests lacking at this time can then be ordered. Active labor is assessed by cervical change over time and is especially important in the patient with an unproven pelvis.

	===Active term labor-multiparous:===		===Active term labor-multiparous:===
	[[See YKHC Clinical Guidelines]]		[[See YKHC Clinical Guidelines]]

JenniferH: /* Antepartum Care */

2020-11-21T08:15:39Z

Antepartum Care

← Older revision		Revision as of 08:15, 21 November 2020
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	===Antepartum Care===		===Antepartum Care===
	This is best done in the village and/or Bethel clinic and follows a specific schedule of tests and evaluations (always assessing for HIGH RISK situations) at any point durin		This is best done in the village and/or Bethel clinic and follows a specific schedule of tests and evaluations (always assessing for HIGH RISK situations) at any point durin


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

JenniferH: /* Pre-eclampsia (PEC) evaluation: */

2020-03-31T00:56:00Z

Pre-eclampsia (PEC) evaluation:

← Older revision		Revision as of 00:56, 31 March 2020
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	Consider a sterile speculum exam for “ferning” and Amnisure® is available (and a nursing standing order). Term premature rupture of membranes (PROM) and preterm PROM (PPROM) are admitted and observed. Nothing special needs to be done for term patients who hopefully will spontaneously transition into active labor. These patients, however, should be cervical ripened/induced or augmented to promote labor by at least 12 hours if they at not progressing. If labor is augmented/induced, huddle with HROB and labor RN to confirm plan. PPROM patients are observed and prevented from labor if at all possible in consultation with HROB, Peds and ANMC Perinatology and should be considered for transfer to ANMC. Consider steroids before transfer.		Consider a sterile speculum exam for “ferning” and Amnisure® is available (and a nursing standing order). Term premature rupture of membranes (PROM) and preterm PROM (PPROM) are admitted and observed. Nothing special needs to be done for term patients who hopefully will spontaneously transition into active labor. These patients, however, should be cervical ripened/induced or augmented to promote labor by at least 12 hours if they at not progressing. If labor is augmented/induced, huddle with HROB and labor RN to confirm plan. PPROM patients are observed and prevented from labor if at all possible in consultation with HROB, Peds and ANMC Perinatology and should be considered for transfer to ANMC. Consider steroids before transfer.
	===Pre-eclampsia (PEC) evaluation:===		===Pre-eclampsia (PEC) evaluation:===
	[[~~Gestational Hypertension~~\|See YKHC Clinical ~~Guidelines~~]]		[[media:Gestational_hypertension.pdf\|See YKHC Clinical Guideline for Gestational Hypertension]]

	The prenatal patient with elevated blood pressure and proteinuria should have PEC blood work done including a urine protein/creatinine ratio. A 24 hour urine collection for protein is no longer considered necessary for this diagnosis. Consult with HROB to determine when delivery (or transfer) is recommended.		The prenatal patient with elevated blood pressure and proteinuria should have PEC blood work done including a urine protein/creatinine ratio. A 24 hour urine collection for protein is no longer considered necessary for this diagnosis. Consult with HROB to determine when delivery (or transfer) is recommended.

Mfaubion: /* Pre-eclampsia (PEC) evaluation: */

2015-10-26T22:38:34Z

Pre-eclampsia (PEC) evaluation:

← Older revision		Revision as of 22:38, 26 October 2015
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	Consider a sterile speculum exam for “ferning” and Amnisure® is available (and a nursing standing order). Term premature rupture of membranes (PROM) and preterm PROM (PPROM) are admitted and observed. Nothing special needs to be done for term patients who hopefully will spontaneously transition into active labor. These patients, however, should be cervical ripened/induced or augmented to promote labor by at least 12 hours if they at not progressing. If labor is augmented/induced, huddle with HROB and labor RN to confirm plan. PPROM patients are observed and prevented from labor if at all possible in consultation with HROB, Peds and ANMC Perinatology and should be considered for transfer to ANMC. Consider steroids before transfer.		Consider a sterile speculum exam for “ferning” and Amnisure® is available (and a nursing standing order). Term premature rupture of membranes (PROM) and preterm PROM (PPROM) are admitted and observed. Nothing special needs to be done for term patients who hopefully will spontaneously transition into active labor. These patients, however, should be cervical ripened/induced or augmented to promote labor by at least 12 hours if they at not progressing. If labor is augmented/induced, huddle with HROB and labor RN to confirm plan. PPROM patients are observed and prevented from labor if at all possible in consultation with HROB, Peds and ANMC Perinatology and should be considered for transfer to ANMC. Consider steroids before transfer.
	===Pre-eclampsia (PEC) evaluation:===		===Pre-eclampsia (PEC) evaluation:===
	[[See YKHC Clinical Guidelines]]		[[Gestational Hypertension\|See YKHC Clinical Guidelines]]

	The prenatal patient with elevated blood pressure and proteinuria should have PEC blood work done including a urine protein/creatinine ratio. A 24 hour urine collection for protein is no longer considered necessary for this diagnosis. Consult with HROB to determine when delivery (or transfer) is recommended.		The prenatal patient with elevated blood pressure and proteinuria should have PEC blood work done including a urine protein/creatinine ratio. A 24 hour urine collection for protein is no longer considered necessary for this diagnosis. Consult with HROB to determine when delivery (or transfer) is recommended.

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	A new Induction Policy exists for all such cases and is kept in the “Induction Book” in the NWing Doc’s Office (YKHC Clinical Guidelines Induction and for each condition of pregnancy may be out-of-date <2011>for these situations). In accordance with this new policy, “HUDDLE” as necessary with HROB and the OB Nursing Staff to develop a plan for delivery.		A new Induction Policy exists for all such cases and is kept in the “Induction Book” in the NWing Doc’s Office (YKHC Clinical Guidelines Induction and for each condition of pregnancy may be out-of-date <2011>for these situations). In accordance with this new policy, “HUDDLE” as necessary with HROB and the OB Nursing Staff to develop a plan for delivery.

	===Vaginal discharge:===		===Vaginal discharge:===
	This requires a sterile-speculum exam (SVE) and appropriate lab studies as part of the evaluation.		This requires a sterile-speculum exam (SVE) and appropriate lab studies as part of the evaluation.