OBSTETRICAL PATIENTS

Transcription

1 Witten: January 1986 Reviewed: 1/87, 1/88, 6/94, 3/01, 5/10 Revised: 2/89, 9/91, 7/96, 7/04, 1/07, 3/13 Policy: Emergency Care Center Policy Manual LSU Health Sciences Center-Shreveport, LA Page 1 of 5 OBSTETRICAL PATIENTS PURPOSE The department of Obstetrics and Gynecology in conjunction with Hospital Administration has determined that the following guidelines should be used with respect to pregnant patients who present to LSUHSC for care. The obstetrical suite is accessible 24 hours a day. POLICY 1. All OB patients who present to the emergency area should be greeted and a brief history taken by an RN on duty. The history should include: A. length of gestation, B. presence and character of contractions, C. time bag of water broke, D. length of bloody show, E. previous obstetrical history and F. any other complaints. 2. Stable females whose gestational period is less than sixteen (16) weeks, will be registered to ECC, greater than sixteen (16) weeks or high risk will be sent to the Labor Unit for treatment. 3. A urine pregnancy test will be obtained whenever possible by the Triage Nurse. If the pregnancy test is positive, the patient will be assigned ESI Category The following protocol will be utilized for OB patients arriving by ambulance in active labor: The patient will be assessed for eminent delivery. A. If the delivery is not eminent, the patient will be escorted to the Labor Unit by an MD or Physician Extender from the Department. B. At first notification of the arrival, by Biotel, telephone, or arrival at the ambulance entrance, UPD is to be notified to hold an elevator. C. The Fire Department or ambulance personnel will still deliver the patient to the Labor Unit, but the ECC staff will accompany them and facilitate the most rapid and safe transport possible. Note: The only exception to this policy will be eminent delivery with presenting body parts. 1

2 Page 2 of 5 5. The following protocol will be utilized for patients in acute distress: A. will be assisted onto a stretcher, moved into the closest private treatment area, and briefly examined by an MD for signs of impending birth. B. University Police Department is to be notified to hold an elevator. C. If the birth is not imminent, the patient will be escorted directly to the Labor and Delivery Unit by an MD or Physician Extender. D. An emergency OB kit will be placed on the stretcher during the transfer. 6. The following protocol will be utilized for patients who present with the birth in progress: A. patients who present with the birth in progress shall be placed in an exam room. B. the cord will be double clamped and cut, and C. the infant suctioned appropriately by the physician or his designee. 7. The following protocol will be utilized after the delivery of the stable infant: A. a brief assessment of Mother and child will be made by the MD. B. If the condition of the patient (s) allow, both will be transported together to the Labor and Delivery Unit. C. The infant should be wrapped in a clean sheet or warm blanket to prevent loss of body heat. 8. The Unit Secretary or another RN on duty shall phone the Labor and Delivery Unit and notify them of the patient s status. 9. Should the infant and/or mother be unstable, they will be registered to ECC and receive stabilizing care prior to transfer. The infant will be registered Baby of and mother s name. 10. If delivery has occurred prior to arrival at the hospital: A. An RN proceeds to the ECC driveway with sterile gloves and an ER Obstetrical Delivery Kit. B. The Faculty MD or the Physician Extender on duty is summoned by the Unit Secretary. C. A stretcher, clean sheets, and blankets are brought to the driveway. D. The MD, Physician Extender or RN assesses the birth process and assists with a normal delivery E The cord is double clamped and then cut. The infant is suctioned and stimulated to cry; immediately wrapped in a sheet for warmth, and held by nursing personnel as the mother is assisted from the car. F. The Mother and infant are placed on a stretcher and brought to the closest private treatment room for a brief assessment by the MD, and then immediately transported directly to the Labor and Delivery Unit. G. The Labor and Delivery Unit shall be notified by phone of the patient s status by the Administrative Coordinator or another RN on duty. 2

3 Page 3 of 5 H. If it is cold outside, the infant is brought inside, but will remain in the unit and be transported to the Labor and Delivery Unit with the mother. Warm blankets for both patients can be readily obtained in the ECC. I. Any infant in distress 1) should be placed in the ECC Trauma Resuscitation Room for possible resuscitation. 2) warm blankets can be obtained from the warmer for an immediate source of heat. Goose neck lamps can also be used as a heat source. 3) Pediatricians and NICU staff can be immediately consulted by the MD/Physician Extender and will respond quickly with a transport incubator if necessary. 4) The MD/Physician Extender will conduct the resuscitation attempts until the arrival of the consulted services. The infant will be registered as an ECC patient in this case. 11. The OB patient who delivers a stillborn infant should be assessed in the same manner as any other OB patient. See in-house policy: S-30-ECC, Stillborn In-house Policy A. After a brief assessment by an MD, the patient will be transported to the Labor and Delivery Unit for evaluation and care by MDs on duty in that area. B. After the pronouncement of death, any baby weighing 350 gms or greater or at 20 weeks gestation shall be considered a stillborn. C. If only the infant has been delivered, the cord should be clamped and cut and the infant placed in the resuscitation room for possible resuscitation. The placenta can be delivered later in the Labor and Delivery Unit. D. If the entire products of conception have delivered, the cord should be cut and clamped and the child and placenta examined. 1) Less than 20 weeks gestation and/ or 350 gms in weight is considered POC and is sent to surgical pathology for further examination. 2) The placenta shall be bagged separately and submitted to surgical pathology for further examination. See the Emergency Care Center Policy Manual, S-30-ECC, Still Born-In-House. 12. The following protocol shall be utilized for patients who present with prolapsed cords, breech, or footling presentations A. should be immediately assessed by an MD or Physician Extender on duty B. then transported immediately by the Physician Extender or MD and an RN to the Labor and Delivery Unit. C. Another RN on duty will phone the Labor and Delivery Unit and give as much information as possible in order to allow the Labor and Delivery Unit to set up for the complicated delivery. 3

4 Page 4 of Should a case ever arise that necessitates an infant being separated from the Mother, A. the RN who takes the infant to the Labor and Delivery Unit or NICU, must submit documentation. B. This documentation will become a permanent part of the medical record because it establishes positive identification of the infant until armbands can be placed on both patients in the Labor and Delivery Unit. Reference Emergency Care Center Policy Manual, S-30-ECC, Still Born-In-House 4

5 Page 5 of 5 APGAR SCORING SCALE SIGN Heart Rate Absent Less than 100 Greater than 100 Respiratory Effort Absent Slow-Irregular Good Cry Muscle Tone Flaccid Some Flexion Active Motion Reflexes/Irritability No Response Grimace Cry Color Blue Body Pink Completely Pink Pale Ext. Blue 5