Fast Stream OB Scenarios

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.

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

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.

Admit to Antepartum testing/holding center as an outpatient

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.

Admit to Antepartum testing/holding center as an outpatient

A G1P0 at 38 weeks gestation presents to the OB triage with complaints of no fetal movements for 12 hours. She states she is contracting irregularly without discomfort and denies spontaneous rupture of membranes. Select action

Admit to Antepartum testing/holding center as an outpatient".

Amanda Huber A G2P1 patient at 32 weeks gestational age presents to the OB triage with complaints of "a small amount of watery greenish vaginal fluid leaking". She states that there is no foul odor to this fluid. She also states, "the baby has not been moving as much today as she usually does," and she feels an increased amount of lower abdominal pressure but denies any sensation of contractions or tightening of her uterus.

Admit to High Risk Antepartum Unit

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.

Admit to High Risk Antepartum Unit

Michelle Lewis A G1P0 at 28 weeks presents to her doctor's office with complaints of back pain and a feeling that "my baby is sitting on my tail bone". She is evaluated as having a fetal heart rate of 158, normal vital signs, urine lab and weight and fundal measurements. She is given a prescription for pain medication and sent home. She presents at the OB triage at 2:00 AM with complaints of back pain that is coming in regular waves despite the pain medication and the warm bath and hot water bottle used to help relieve her discomfort. She states she is experiencing an increase in vaginal mucous as well and feels she has "a touch of the stomach flu" with cramping and loose stools reported.

Admit to High Risk Antepartum Unit

Patricia Moore A G4P0 at 24 weeks presents to OB triage with complaints of lower back pain that comes "in waves from my low back wrapping around to just under my ribs" for the last 8 hours. She is afraid she may have a "yeast infection" because she noticed an increase in her vaginal discharge, but denies any vaginal burning, discomfort, itching or foul odor to the discharge. She admits that she has had "no prenatal care so far" and was told by her friend that the vaginal pinkish spotting she noticed about an hour ago isn't normal. She has felt the baby moving today but noticed that her stool was looser than it has been in the past, her stomach is cramping, and she feared she may have gotten some food poisoning.

Admit to High Risk Antepartum Unit

Tammy Taylor A G1P0 presents to the emergency department at 29 weeks with decreased fetal movements. She admits that she has been non-compliant with her exercise and prescribed diet and daily glucose checks that were prescribed by her provider because of an abnormally high result on both her Oral Glucose Challenge test (OGCT) followed by an abnormally high Oral Glucose Tolerance Test (OGTT). She feels very fatigued and has had a sudden increase in her weight over the last month and states she has skipped her last 2 prenatal visits as well. She states that the baby hasn't had normal movements for the last 8 hours.

Admit to High Risk Antepartum Unit

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.

Admit to High Risk Antepartum Unit

Vickie Dunn A G1P0 presents at 35 weeks pregnant with complaints of decreased fetal movements and severe upper right quadrant pain that has persisted for 24 hours. She denies bloody show, uterine contractions or tightenings of any kind. She has a "migraine headache and seeing spots" that has not been relieved with OTC Tylenol and Ice packs for the last 8 hours. She states she weighs 5 pounds more in the office than last week and has had "a lot more swelling" than before. Her BP in the office is 160/98; pulse 90, and 2+ protein was shown in her urine. She states she feels ill and tired but is not sure exactly what is causing her to feel this way, as she has been resting for the last 2 days.

Admit to High Risk Antepartum Unit

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.

Admit to Labor & Delivery

Bethany Driver A G3P1 at 39 weeks gestational age presents to the OB Triage area with complaints of a large "gush" of clear amniotic fluid that occurred over one hour ago that occurred in her obstetrician's office. The office confirmed that a spontaneous rupture of the bag of water has occurred. She states no decrease in fetal movements and denies any vaginal bleeding. She is currently experiencing NO contractions or labor pain of any kind.

Admit to Labor and Delivery Unit

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.

Admit to Labor and Delivery Unit

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.

Admit to Labor and Delivery Unit

Judy Pruitt A G3P1 patient at 39 weeks has been laboring at home for the last 12 hours. She is tired and has not slept. Her contractions grew in intensity and in frequency and she experienced bloody show earlier in the day. She was checked at her physician's office 2 hours ago and her cervix was found to be 3 cm dilated and 80% effaced (she was 1-2 cm and 50% effaced at her last prenatal visit a week ago). She is measuring 2 cm greater than her dates and has been diagnosed with gestational diabetes at 25 weeks. She has treated her gestational diabetes correctly with scheduled blood glucose monitoring, exercise and an ADA diet. While in route to the hospital, she noticed that her contractions began to space out and are now no longer as intense. When getting out of her car in the parking lot, she noticed that she felt a sudden and constant trickle of fluid vaginally, and at the OB triage desk presents with saturated jeans.

Admit to Labor and Delivery Unit

Kate Nelson A G4P2 presents to OB triage with gestational age of 39 weeks with complaints of warm, green fluid leaking for the last 1 hour "a little at a time" from her vagina, appearing on her sanitary pad. She states that the fluid has a greenish color but denies foul odor. She has been feeling uterine contractions coming irregularly every 5 min for the last 5-6 hours and over the last hour they have become much more uncomfortable. She states that the infant is moving "as he usually does".

Admit to Labor and Delivery Unit

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.

Admit to Labor and Delivery 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%.

Admit to Labor and Delivery Unit

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 (GDM)

Tammy Taylor A G1P0 presents to the emergency department at 29 weeks with decreased fetal movements. She admits that she has been non-compliant with her exercise and prescribed diet and daily glucose checks that were prescribed by her provider because of an abnormally high result on both her Oral Glucose Challenge test (OGCT) followed by an abnormally high Oral Glucose Tolerance Test (OGTT). She feels very fatigued and has had a sudden increase in her weight over the last month and states she has skipped her last 2 prenatal visits as well. She states that the baby hasn't had normal movements for the last 8 hours.

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. Select term

HELLP Syndrome

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

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

Incompetent Cervix

Odelinda Baker A G1P0, 16-week gestational age patient presents to her certified nurse midwife's (CNM) office with no complaints except "pink vaginal mucous". The CNM examines her cervix and finds the cervix to be 4 cm dilated and 50% effaced with a bulging bag of membranes. The CNM is transferring the patient to the hospital for immediate treatment.

Incompetent Cervix

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

"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

Amanda Huber A G2P1 patient at 32 weeks gestational age presents to the OB triage with complaints of "a small amount of watery greenish vaginal fluid leaking". She states that there is no foul odor to this fluid. She also states, "the baby has not been moving as much today as she usually does," and she feels an increased amount of lower abdominal pressure but denies any sensation of contractions or tightening of her uterus.

Meconium Staining

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

Kate Nelson A G4P2 presents to OB triage with gestational age of 39 weeks with complaints of warm, green fluid leaking for the last 1 hour "a little at a time" from her vagina, appearing on her sanitary pad. She states that the fluid has a greenish color but denies foul odor. She has been feeling uterine contractions coming irregularly every 5 min for the last 5-6 hours and over the last hour they have become much more uncomfortable. She states that the infant is moving "as he usually does".

Meconium Staining

"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

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

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

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. Select term

Post Term Pregnancy

"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

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.

Preeclampsia

Vickie Dunn A G1P0 presents at 35 weeks pregnant with complaints of decreased fetal movements and severe upper right quadrant pain that has persisted for 24 hours. She denies bloody show, uterine contractions or tightenings of any kind. She has a "migraine headache and seeing spots" that has not been relieved with OTC Tylenol and Ice packs for the last 8 hours. She states she weighs 5 pounds more in the office than last week and has had "a lot more swelling" than before. Her BP in the office is 160/98; pulse 90, and 2+ protein was shown in her urine. She states she feels ill and tired but is not sure exactly what is causing her to feel this way, as she has been resting for the last 2 days.

Preeclampsia

"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

Michelle Lewis A G1P0 at 28 weeks presents to her doctor's office with complaints of back pain and a feeling that "my baby is sitting on my tail bone". She is evaluated as having a fetal heart rate of 158, normal vital signs, urine lab and weight and fundal measurements. She is given a prescription for pain medication and sent home. She presents at the OB triage at 2:00 AM with complaints of back pain that is coming in regular waves despite the pain medication and the warm bath and hot water bottle used to help relieve her discomfort. She states she is experiencing an increase in vaginal mucous as well and feels she has "a touch of the stomach flu" with cramping and loose stools reported.

Premature Labor

Patricia Moore A G4P0 at 24 weeks presents to OB triage with complaints of lower back pain that comes "in waves from my low back wrapping around to just under my ribs" for the last 8 hours. She is afraid she may have a "yeast infection" because she noticed an increase in her vaginal discharge, but denies any vaginal burning, discomfort, itching or foul odor to the discharge. She admits that she has had "no prenatal care so far" and was told by her friend that the vaginal pinkish spotting she noticed about an hour ago isn't normal. She has felt the baby moving today but noticed that her stool was looser than it has been in the past, her stomach is cramping, and she feared she may have gotten some food poisoning.

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

Bethany Driver A G3P1 at 39 weeks gestational age presents to the OB Triage area with complaints of a large "gush" of clear amniotic fluid that occurred over one hour ago that occurred in her obstetrician's office. The office confirmed that a spontaneous rupture of the bag of water has occurred. She states no decrease in fetal movements and denies any vaginal bleeding. She is currently experiencing NO contractions or labor pain of any kind.

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. Select term

Premature Rupture of Membrane (PROM)

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.

Prepare for Surgical Intervention or Cesarean Section

Kathy Williams A G2P1 40-week gestational age has been in labor and delivery for more than 8 hours for induction of labor. The patient is receiving IV Pitocin to increase the strength and frequency of the contractions. She is 5-6 cm. dilated. Spontaneous rupture of membranes occurs as the nurse is checking for vaginal dilation. The nurse notices that the fetal heart rate abruptly decelerates in a "V" shaped pattern to 30-40 beats per minute. The nurse repeats the vaginal exam to assess for the cause of the deceleration and palpates a "pulsing protrusion" in the vaginal area. The nurse pushes the fetal head away from the cervix and the "pulsing protrusion" and elevates the mother's hips and calls for additional medical help so that other immediate interventions can take place.

Prepare for Surgical Intervention or Cesarean Section

Odelinda Baker A G1P0, 16-week gestational age patient presents to her certified nurse midwife's (CNM) office with no complaints except "pink vaginal mucous". The CNM examines her cervix and finds the cervix to be 4 cm dilated and 50% effaced with a bulging bag of membranes. The CNM is transferring the patient to the hospital for immediate treatment.

Prepare for Surgical Intervention or Cesarean Section

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 or Cesarean Section".

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.

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

Kathy Williams A G2P1 40-week gestational age has been in labor and delivery for more than 8 hours for induction of labor. The patient is receiving IV Pitocin to increase the strength and frequency of the contractions. She is 5-6 cm. dilated. Spontaneous rupture of membranes occurs as the nurse is checking for vaginal dilation. The nurse notices that the fetal heart rate abruptly decelerates in a "V" shaped pattern to 30-40 beats per minute. The nurse repeats the vaginal exam to assess for the cause of the deceleration and palpates a "pulsing protrusion" in the vaginal area. The nurse pushes the fetal head away from the cervix and the "pulsing protrusion" and elevates the mother's hips and calls for additional medical help so that other immediate interventions can take place.

Umbilical Cord Prolapse

Judy Pruitt A G3P1 patient at 39 weeks has been laboring at home for the last 12 hours. She is tired and has not slept. Her contractions grew in intensity and in frequency and she experienced bloody show earlier in the day. She was checked at her physician's office 2 hours ago and her cervix was found to be 3 cm dilated and 80% effaced (she was 1-2 cm and 50% effaced at her last prenatal visit a week ago). She is measuring 2 cm greater than her dates and has been diagnosed with gestational diabetes at 25 weeks. She has treated her gestational diabetes correctly with scheduled blood glucose monitoring, exercise and an ADA diet. While in route to the hospital, she noticed that her contractions began to space out and are now no longer as intense. When getting out of her car in the parking lot, she noticed that she felt a sudden and constant trickle of fluid vaginally, and at the OB triage desk presents with saturated jeans.

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

Kathy Mann A G1P0 patient at 40 weeks gestational age has been contracting at home for 12 hours. In the last hour, the contractions have slowly decreased in intensity and are irregular in frequency. She reports that she had a spontaneous rupture of the amniotic membrane that occurred an hour ago and the color of the fluid was clear and was of a moderate amount and there was no foul odor. Her cervical exam was done in the doctor's office 2 hours ago and she was found to be 2 cm dilated and 80% effaced (she was 1 cm and 50% at her last prenatal visit a week ago).

Augmentation of Labor AdmittoLaborAndDeliveryUnit

"An obstetrical complication in which the placenta is inserted partially or wholly in the lower uterine segment. It is a leading cause of antepartum bleeding and hemorrhage (vaginal bleeding) and can be life-threatening to the fetus and to the mother."

Placenta Previa

Sue Brown A G2P1 presents to the Emergency department with no previous history of prenatal care. She is having some spotting and uncomfortable contractions. She is unsure of her due date, but her gravid abdominal measurement is at 28 cm. She states that she thinks she has been pregnant for "about 7 months".

Placenta Previa

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. Select action

Admit to Antepartum testing/holding center as an outpatient

"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

"An antepartum diagnostic examination to determine fetal well-being in utero. Stimulation of the uterus is accomplished by either nipple stimulation or use of IV Pitocin if spontaneous "rhythmic uterine tightenings" are not already present. Fetal monitoring is done to assess tolerance of the Fetus during and after these "rhythmic uterine tightenings" , and whether signs of fetal hypoxia are present as evidenced by fetal heart rate changes."

Contraction Stress Test (CST)

A G1P0 at 38 weeks gestation presents to the OB triage with complaints of no fetal movements for 12 hours. She states she is contracting irregularly without discomfort and denies spontaneous rupture of membranes.

Contraction Stress Test (CST)

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.

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)

"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)

"Amniotic fluid that contains products of the fetus's first bowel movement in utero. The presence of this in the fluid is not harmful to the fetus in utero; however, aspiration of the fluid by the infant at or after delivery may result in respiratory complications, infection and/or other serious complications. Careful assessment of the time, amount, color and odor of the amniotic fluid is of high priority, prior to birth."

Meconium Staining

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

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

Post Term Pregnancy

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.

Prepare for Surgical Intervention or Cesarean Section

KarenScott 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.

Umbilical Cord Prolapse

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.

Admit to Antepartum testing/holding center as an outpatient

Sue Brown A G2P1 presents to the Emergency department with no previous history of prenatal care. She is having some spotting and uncomfortable contractions. She is unsure of her due date, but her gravid abdominal measurement is at 28 cm. She states that she thinks she has been pregnant for "about 7 months".

Admit to High Risk Antepartum Unit

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.

Admit to Labor and Delivery Unit

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.

Admit to Labor and Delivery Unit

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)

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

Abruptio Placentae