OB
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 or Cesarean Section",
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
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
A G1P0 at 28 weeks gestational age presents to the emergency department with complaints of bright red vaginal spotting. She denies contractions, tightening, or abdominal pain of any kind, but states a history of being diagnosed with a condition that involves "the placenta implanted completely over the cervical opening." She states this was based on ultrasound findings. The prenatal record confirms this finding. The fetal heart rate is 150's with frequent accelerations and moderate variability. She states active fetal movements. She has a small amount of bright red vaginal bleeding present on her pad.
Placenta Previa". "Admit to High Risk Antepartum 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 (CST)" "Admit to Antepartum testing/holding center as an outpatient",
Vanisha Wilder 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 term
"Contraction Stress Test (CST)", "Admit to Antepartum testing/holding center as an outpatient",
"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".
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 condition in pregnancy associated with preeclampsia whereby the pregnant patient experiences a critical hemolysis, elevated liver enzymes and low platelet count."
"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
"A condition in which the neck of the lower uterine segment begins to open, or dilate, in the second trimester of pregnancy."
"Incompetent Cervix"
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", "Prepare for Surgical Intervention or Cesarean Section",
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",
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/holding center as an outpatient
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
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",
A G1P0 at 39 weeks gestational age presents to the OB triage with complaints of "leakage of vaginal fluid" persistently for the last 2 hours. She states the fetal movement is normal and that there was no foul odor or abnormal color to the fluid. She is confused because she has had no uterine contractions or cramping of any kind and is concerned she "may just be leaking urine now that the baby is so low".
"Premature Rupture of Membrane (PROM)". "Admit to Antepartum testing/holding center as an outpatient".
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 Admit to Labor and Delivery Unit"
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 Admit to Labor and Delivery Unit
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 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 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) 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. Select term
HELLP Syndrome" 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",
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 labor.
Nonstress Test", "Admit to Antepartum testing/holding center as an outpatient"
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 that has exceeded 42 weeks gestation without delivery of the fetus or signs or symptoms of natural labor
Postterm 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
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.
PreeclampsiaAdmit to High Risk Antepartum Unit
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 Admit to High Risk Antepartum 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)"
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.
ms "Admit to Labor and Delivery Unit",
A pregnancy that has exceeded 42 weeks gestation without delivery of the fetus or signs or symptoms of natural labor."
post term pregnancy
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
