Obstetrics

"A condition in which the neck of the lower uterine segment begins to open, or dilate, in the second trimester of pregnancy."

Incompetent Cervix

Rita Ray A G1P0, 32-week gestational age patient presents to the ER with complaints of premature contractions for the last 6 hours. The patient had a cerclage placed at 16 weeks.

Incompetent Cervix Admit to High Risk Antepartum Unit

Tina White A G2P0 16-week gestational age patient arrives in the antepartum triage with complaints of premature painless contractions coming in an irregular pattern for the last 12 hours. The nurse receives orders from her physician to check the patient's cervix. The nurse finds that the cervix is dilated to 3-4 cm with a bulging bag of membranes.

Incompetent Cervix Prepare for Surgical Intervention

"An inpatient procedure whereby contractions of the uterus and/or cervical dilation are initiated in the absence of natural labor by artificial rupture of amniotic membranes (AROM), and/or cervical ripening agents and/or IV oxytocin."

Induction of Labor

Joey Kelly A G1P0 was admitted to the high-risk antepartum unit due to signs and symptoms of Preeclampsia yesterday. She has received Magnesium Sulfate IV and her blood pressure and reflexes have decreased. She is 41 weeks gestational age and an ultrasound has shown that the infant has intrauterine growth restriction. A nonstress test was done and the fetus is reactive, and movements are regular.

Induction of Labor Admit to Labor and Delivery Unit

"An antepartum fetal surveillance procedure carried out after 28 weeks gestational age exam. By fetal heart rate monitoring and the mother marking the movements of the fetus, this exam detects fetal well-being by recording movement, heart rate and reactivity of the heart rate of the fetus. Abnormal results lead to immediate further exploration of the fetal condition."

Nonstress Test

Chantel Foster A G4P2 at 38 weeks gestational age presents to the emergency department with active labor and a moderate amount of greenish fluid is noted leaking from the vaginal opening when her cervix is examined by the ER doctor and found to be at 5-6 cm. dilated and 80% effaced. Testing confirms that it is amniotic fluid. There is no foul odor to the fluid and the patient is afebrile. She is having regular 60-90 second contractions every 5 minutes and her pain is an 8 out of 10 at the peak of each contraction. The Fetal heart rate is 130 with moderate variability with few accelerations.

Meconium Staining Admit to Labor and Delivery Unit

Peg Smith A G2P3 at 38 weeks gestational age presents to the emergency department with a diagnosis of Placenta Previa. She is complaining of a large amount of bright red bleeding and she continues to actively bleed on the waterproof pad on the mattress. She has active, painful, regular contractions every 2-5 minutes for the last hour. The fetal heart rate is present at 120 beats per minute and variability is minimal and accelerations are absent.

Placenta Previa Prepare for Surgical Intervention or Cesarean Section

Taryn Jones A G1P0 at 32 weeks presents to her obstetrician's office with complaints of sudden increase in weight and generalized edema. She has 3+ pitting edema in her legs, 2+ deep tendon reflexes bilaterally and complains of "persisting indigestion" or epigastric pain. She has noticed that Tylenol taken every 4 hours has done little to relieve her headache over the last 24 hours. Her BP is 180/96, pulse 88, respiratory rate is 18/min, and oral temperature is 97.9 F. A urine specimen was taken in the office and showed 2+ protein.

Pleeclampsia Admit to High Risk Antepartum Unit

"A pregnancy that has exceeded 42 weeks gestation without delivery of the fetus or signs or symptoms of natural labor."

Post Term Pregnancy

"Premature separation of the placenta from the wall of the uterus before birth."

Abruptio Placentae

Kristy Turner A G3P2 is presenting to the Maternity unit with complaints of "falling in her bathroom and hitting her abdomen on the bathtub." She is 38 weeks and complains of persisting contractions that "don't let up" and active fetal movements. She is having small amounts of bright red spotting for the last hour.

Abruptio Placentae Admit to Antepartum High Risk

Missy Matthews A G1PO at 38 weeks presents to the Emergency department with large amounts of bright red vaginal bleeding actively leaking following what she referred to as "a hit and run rear-end automobile accident." She states no ambulance was called to the scene and she drove herself to the ER. She presents to the ER with a firm, board-like abdomen and complains of no relaxation and persisting pain to the uterus. She is restless and unable to relax her body. When transporting the patient from the Emergency department, the fetal heart rate baseline is reported by fetal monitor to be 50 beats per minute with late decelerations. Resting tone of the uterus is absent between contractions.

Abruptio Placentae Prepare for Surgical Intervention or Cesarean Section

"An inpatient procedure whereby preexisting labor is assisted in its progress in strength and frequency of uterine contractions and/or dilation and effacement in the cervix by Artificial Rupture of the Amniotic Membranes (AROM), and/or cervical ripening agents and/or IV oxytocin."

Augmentation of Labor

Linda Hunter A G1P0 at 41 1/7 weeks gestational age presents to the OB triage desk with complaints of active labor that has lasted for the last 20 hours. Her doctor has sent her over from the office and when checking the cervix noted that the patient had an intact bulging bag of amniotic membrane and a cervical exam of 3-4 cm. dilation and 80% effacement. The patient states active fetal movements and FHR of 120's in the doctor's office. This report was confirmed by the physician over the phone.

Augmentation of Labor Admit to Labor and Delivery Unit

Precious Vines A G3P2 at 38 weeks with a diagnosis of intrauterine growth restriction has been sent over from her OB doctor's office with orders for a biophysical profile. The patient denies any signs of labor currently.

Contraction Stress Test Admit to Antepartum Testing

Stacy Ingalls A G2P1 at 38 weeks gestational age presents to Maternity unit from the Emergency department reporting that she has received no prenatal care in this pregnancy. She has no complaints of labor, or leakage of fluid, but feels she needs to "make sure the baby is okay" and states no fetal movements in a 2-day period. She states she is having "painless tightening of her uterus" irregularly but denies any bloody show or leakage of fluid vaginally. It is evident that a ___________ needs to be carried out immediately.

Contraction Stress Test (CST) Admit to Antepartum testing/holding center as an outpatient

Joann Rice A G2P1 at 38 weeks has been in the OB Antepartum testing area for the last 2 hours. Her Nonstress test was reactive and she has no contractions or abnormal discharge or fluid of any kind vaginally. Her blood glucose Accu-Check was within normal limits after lunch. Her fetus is active, and she has no complaints of any discomfort. She has a diagnosis regarding her glucose intolerance in pregnancy and is following an ADA diet and exercising regularly. She is currently having irregular Braxton-Hicks contractions and her cervix is <1 cm and 50% effaced.

Gestational Diabetes Mellitus Discharge home

"A condition of glucose intolerance, with no pre-existing occurrence, that begins and is diagnosed during pregnancy only. This condition is diagnosed between 24-28 weeks gestational age by an oral 50-gram glucose challenge test (GCT) during prenatal care. If results are abnormal, a 100-gram oral glucose tolerance test (OGTT) is carried out for confirmation of the diagnosis. Classifications of this disorder include A1-(diet control) and A2 (insulin control with diet). Maternal treatments include self-glucose monitoring, diet, exercise and close maternal and fetal surveillance. This condition can lead to fetal macrosomia or large for gestational age fetus (LGA), cephalopelvic disproportion (CPD), Cesarean Section and hypoglycemia, hyperbilirubinemia (Jaundice), respiratory distress syndrome (RDS) or hypocalcemia of the newborn."

Gestational Diabetes Mellitus (GDM)

"A condition in pregnancy associated with preeclampsia whereby the pregnant patient experiences a critical hemolysis, elevated liver enzymes and low platelet count."

HELLP Syndrome

Carol Tanner A G2P1 patient at 38 weeks gestation presents to the Emergency Department with a persisting headache lasting >24hrs and "blurry vision". She states she feels very tired and "puffy" and noticed her feet and fingers are more swollen than the day before. Her face, hands, feet and legs are edematous. Her reflexes are brisk, bilaterally, and her blood pressure is 160/95 on the right arm and 158/98 on the left arm. She states that her baby has been actively kicking and moving regularly in the last hour and the monitor strip shows a Fetal Heart Rate baseline from 142-144 with moderate variability. She states she came to the Emergency department because she feels ill and complains of a persisting pain in the upper right quadrant of her abdomen. She continues to deny any sensation of uterine contractions or discomfort otherwise. Her uterus is soft, and she denies any complaints of "bloody show", abnormal discharge, or leakage of amniotic fluid vaginally. She has no fever, and denies vomiting, nausea or diarrhea.

HELLP Syndrome Admit to High Risk Antepartum Unit

Rosie Holloway A G1P0 at 38 weeks is transferred to the Antepartum holding/testing area from her doctor's office for monitoring and evaluation. In the office her cervix was 2-3 cm and 50% effaced. Earlier in the day, on admission, she had complained of irregular contractions and a persistent headache for the last 24 hours and decreased fetal movements as well as complaints of heart burn that had not been relieved with the OTC Tums. Blood pressures are 160-180/90-100. After 2 hours on the monitor the uterine activity monitor shows regular uterine contractions every 2-5 minutes apart, with the patient complaining of pain with a 7 out of 10 pain scale. The fetal heart rate of 130 has minimal to moderate variability and an absence of accelerations. Non-reassuring decelerations are currently ABSENT. Many of the patient's blood tests are pending; however, the labs that have been received are showing a low platelet count, elevated (ALT, AST) liver enzymes. Urine test is 2+ for protein. The patient's cervix is examined again and is now 3-4 cm dilated and 80%.

HELLP Syndrome Admit to Labor and Delivery Unit Explanation: This patient should be transferred immediately to the labor and delivery unit. She is showing signs and symptoms of active labor as evidenced by her contraction strength, regularity, and, most importantly, her cervical change. What is most concerning are the present signs of a low platelet count, and elevated liver enzymes. She also complains of epigastric pain which could be signs of enlargement of the liver. All these signs and symptoms are common with the condition known as HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets). Due to her proteinuria and elevated blood pressure, preeclampsia must also be ruled out. The fetus is showing a lack of reactivity and must be monitored closely by an experienced RN in labor and delivery. Treatments are needed for the elevated blood pressure. The mother may require critical care if it is determined that she indeed has HELLP syndrome.

Sally Johnson A G1P0 patient at 35 weeks gestational age patient presents to the Maternity unit from her Obstetrician's office with complaints of a lack of sensation of fetal movement for an 8-hour period while at home. Fetal heart rate was 120's by Doppler assessment. She has had little to drink and has been shopping most of the day. She denies having any symptoms of contractions

Nonstress Test Admit to Antepartum testing/holding center as an outpatient

Tanisha Green A G4P3 patient at 35 weeks gestational age presents to the Maternity unit with complaints of working a 12-hour shift as a nurse and stating, "I have not felt the baby move the entire day." She reports that she has skipped her lunch at work due to a busy shift. She denies complaints of discomfort or contractions or bloody show.

Nonstress test Admit to Antepartum testing

Ikesha Taylor A G2P1 at 36 weeks gestational age has been diagnosed with Gestational Diabetes at 26 weeks gestation. Her weekly antepartum surveillance exam is due. She presents to the maternity unit with no complaints of contractions or signs of labo

Nonstress test Admit to outpatien

Jennifer Holly A G3P2 at 42 2/7 weeks gestational age presents to labor and delivery from her obstetrician's office. She has had no signs of labor. She has not been sleeping well and states she "is exhausted". She has noticed a decrease in fetal movements over the last 24 hours and she was concerned. Monitoring in the office resulted in a non-reactive nonstress test. An ultrasound was done that showed a decrease in amniotic fluid or oligohydramnios. Currently, she denies any signs of labor or vaginal discharge or fluid.

Post Term Pregnancy Admit to Labor and Delivery Unit

A pregnancy-related complication of unknown cause that is characterized by high blood pressure (when pre-pregnancy BP's were normal) and signs of damage to other organ systems such as the kidneys, leading to a condition known as proteinuria. Usually begins after 20 weeks of pregnancy and if left untreated can lead to serious, even fatal, complications for the mother and the baby."

Preeclampsia

Jessica Sims A G2P1 at 32 weeks gestation presents to the emergency department with no history of prenatal care. She has sought out medical care for complaints of a migraine-like headache that has persisted for the last 24 hours. She has generalized edema especially in her face and hands. She is complaining of "seeing spots" before her eyes and generally feeling ill. Vital signs are BP of 170/110, pulse 89, respiratory rate 20/min and oral temperature is 98.2 F. A urine specimen taken in the ER shows 2+ protein. She states no pain or discomfort in her abdomen and denies any sensations of contractions. She states no present discharge or leakage of fluid vaginally. The term you selected, "Pr

Preeclampsia Admit to High Risk Antepartum Unit

"A maternal condition defined by the progressive dilation and effacement of the cervix that begins after 20 weeks and before term (the 37th week of pregnancy). This condition occurs because risk factors that are known or unknown cause uterine contractions and the cervix to dilate and efface prior to the time that the fetus is considered Term or 37-41 weeks. Many known and unknown causes for the condition exist. This condition is the leading cause of morbidity and mortality of newborns."

Premature Labor

Phyliss Deisenroth A G5P4 presents to OB triage at 32 weeks gestational age with complaints of leakage of a moderate amount of clear fluid vaginally that "soaked her jeans" She states her last baby was born at 33 weeks gestational age. She states a discomfort when her abdomen "tightens up" and states her contractions/tightenings are regular every 3-4 minutes. She has a history of rapid labors. She is crying and upset and states that she felt some loose stools and cramping last night but thought it was just " the spicy food" that she had eaten. When she awoke this morning, she reported the cramping had remained the same, but now the loose stools and regular tightenings of her abdomen began. She states she currently feels active fetal movements.

Premature Labor Admit to Labor and Delivery Unit

"The breaking/leaking of what a patient refers to as their "bag of water" before natural labor has taken place at term (37-41 weeks gestation)."

Premature Rupture of Membrane (PROM)

Maggie Maxwell A G2P1 at 38 weeks gestational age presents to the ER at 1:00 AM with complaints of decreased fetal movements over the last 3-4 hour period. She states that after emptying her bladder and returning to bed she noticed a small gush of vaginal fluid leaking down her leg. She states that the fluid was clear and colorless and denied foul odor. She states that the irregular tightenings she usually feels every evening were absent tonight, and she currently feels no discomfort at all in her uterus

Premature Rupture of Membrane (PROM) Admit to Antepartum testing/holding center as an outpatient

Chastidy Haswell A G1P0 at 40 weeks gestational age presents to OB Triage with complaints of a constant leakage of small amounts of clear fluid vaginally for the last 3 hours. She denies any foul odor to the fluid and denies any sensation of contractions. The physician checked her cervix yesterday in the office and found it to be 1-2 cm. dilated and 50% effaced. The position of the fetus had been at a -3 station.

Premature Rupture of Membranes Admit to Antepartum Holding area

Jordan Wright A G1PO at 38 weeks presents to the Emergency department with no history of prenatal care other than an ultrasound in the first trimester that confirmed gestational age . The patient has admitted to a history of cocaine abuse and states that she had her last incident of use approximately 1 hour ago. The pt. complains of sudden stabbing pain to the abdomen 30 min after snorting cocaine, and continues to complain of bright red vaginal bleeding of large amount persistently for the last 30 min,Bright red bleeding is currently pooling on the water resistant pad on the stretcher. She is crying out in intense pain as report from the ER nurse is received. The fetal monitor strip taken in the ER indicates a sudden drop in the fetal heart rate of 40-50 beats per minute as a baseline with minimal variability. Uterine resting tone is absent, and the abdomen is hard and board-like.

Prepare for Surgical Intervention

Michelle Davis A G1P0 at 30 weeks gestational age carrying a multifetal pregnancy has had a spontaneous rupture of membranes (SROM) when getting out of the elevator at the hospital and presents to the OB Triage with complaints that "something strange feels like it's coming out." The nurse can see when placing the woman in a stretcher that the umbilical cord has prolapsed out of the vagina.

Umbilical Cord Prolapse Prepare for Surgical Intervention or Cesarean Section

"A complication that occurs prior to, or during, delivery of the baby. This condition occurs when the "pulsing life-line" which connects the placenta to the fetus drops through the open cervix into the vagina ahead of the baby becoming trapped and totally or partially occluded against the baby's body during delivery. This complication occurs in one in every 300 births and presents a great danger to the fetus. It can result in hypoxia or death to the fetus if intervention is not initiated immediately."

Umbilical cord prolapse

Karen Scott A G1P0 is admitted to the Antepartum holding area as an outpatient to be monitored for complaints of regular moderately uncomfortable uterine contractions lasting 60-80 seconds occurring every 2-5 minutes. Her cervix was examined for dilation and effacement and found to be 2-3 centimeters and 100% effaced. The patient complains of a "sudden large gush" of warm amniotic fluid between her legs following the vaginal exam. When the nurse is cleaning up the fluid on the bed and changing the waterproof pad a protrusion is visualized coming out of the patient's vagina. The fetal heart rate has dropped suddenly to 40 beats per minute. The nurse quickly repositions the patient, does a vaginal examination and pushes the fetal presenting part away from the protrusion.

Uterine prolapse Prepare for surgical intervention