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Care of the Pregnant Patient NON-TRAUMA (8.61)

Care of the Pregnant Patient NON-TRAUMA (8.61) - Policies, Clinical, UWHC Clinical, UWHC-wide, Patient Care

8.61



8.61 Care of the Pregnant Patient NON-TRAUMA
Category:

UWHC Administrative Policy Print
Policy Number:

8.61

Effective Date:

November 1, 2014

Version:

Revision

Section:

Patient Care (Hospital Administrative)



I. PURPOSE

To define the plan of care for meeting the needs of the non-trauma pregnant patient.

II. POLICY

The following general guidelines will be considered when assessing the appropriate care setting for pregnant
patients requiring hospitalization.
A. Greater than 20 weeks gestation:
1. Generally not appropriate for admission to UWHC.
2. Exceptions will be determined by consultation.
a. Notify the attending caring for the pregnancy.
b. If the patient does not have a physician identified to care for the pregnancy,
consultation (phone or in-person) should occur with the Maternal Fetal Medicine
Attending on-call.
c. The immediate availability of perinatal (maternal/fetal medicine and neonatology)
services may be a critical factor in the successful care of a pregnant woman and her
fetus. Admission to UWHC should be for the purpose of stabilizing the patient for safe
transfer or providing services not available elsewhere (e.g., level I trauma care,
plasmapheresis, management of malignancy). Refer to Hospital Administrative Policy
7.12-Emergency Assessment at UWHC Facilities.
B. Less than 20 weeks gestation:
1. The Obstetric service needs to be notified of all known pregnant patients prior to any planned or
unplanned admission to UWHC. This can be accomplished via telephone discussion or formal in-
person consultation, as relevant based on weeks of gestation, nature of condition requiring
treatment, and treatment plan.
2. Notify the physician caring for the patient's pregnancy to determine appropriateness of admission
to UWHC (either OB consult or patient’s obstetrician). If a patient has been admitted without
being able to contact their primary obstetrical provider, the Maternal Fetal Medicine service will
contact them.
3. If the patient does not have a physician identified to care for the pregnancy, notify the CSC
Senior OB/GYN Resident, who will consult with the Maternal Fetal Medicine Attending on-call to
determine appropriateness of admission to UWHC.
III. DEFINITION

The physician managing the pregnancy may be a practitioner in Obstetrics/Gynecology or a Family Medicine
Practitioner who provides obstetric care.

IV. PROCEDURE
A. Admission and care of the pregnant patient less than 20 weeks gestation:
1. Notify the primary obstetrical provider caring for the pregnancy and/or the CSC Senior OB/GYN
resident for assessments related to pregnancy needs.
2. Attending physician caring for the pregnancy will complete pregnancy and medical history.
3. Assess fetal heart rate (FHR) with a Doppler. Depending on age of gestation, fetal heart tones
may be difficult to discern. Generally, heart tones should be able to be heard with a Doppler at
around 10-12 weeks gestation. They are often heard the best in the mother's right or left lower
quadrant, depending on fetal position. Normal FHR ranges from 110-160. Report any abnormal
fetal heart rates to the physician.
4. Assess patient's comfort level using the approved pain scale.
5. Assess for cramping, vaginal bleeding, or leaking of amniotic fluid.
6. Provide ongoing emotional support to the patient and her family.
7. Document all information in the patient’s electronic medical record.

B. Care of the laboring patient who is less than 20 weeks gestation:
1. Notify the Nurse Manager (weekdays) or the Nursing Coordinator (weekends and off shifts).
2. Notify the attending physician caring for the pregnancy and/or the CSC Senior OB/GYN Resident
to assess maternal/fetal status and labor progress.
3. Assess FHR with a Doppler.
4. Assess for cramping, vaginal bleeding, or leaking of amniotic fluid.
5. Assess pain status using approved pain scale.
6. Obtain vital signs.
7. Gather equipment and supplies for on-unit treatment or prepare patient for procedure as
indicated. The emergency delivery tray is located in the Emergency Department.
8. Document all information in the patient’s electronic medical record.
V. REFERENCES

The American College of Obstetricians and Gynecologists, Standards for Obstetric-Gynecologic Services
Nursing Patient Care Policy 16.10A-Nursing Care of the Pregnant Trauma Patient (Adult)
Hospital Administrative Policy 7.12-Emergency Assessment at UWHC Facilities
RTS Bereavement Services Guidelines. http://www.gundersenhealth.org/resolve-through-sharing
Proehl, J. A. (2009). Emergency nursing procedures (4th Ed.). St. Louis, MO: Saunders Elsevier.

VI. COORDINATION

Sr. Management Sponsor: SVP, Patient Care Services & CNO
Author: Director, Nursing Practice Innovation

Review/Approval Committee(s): Nursing Patient Care Policy & Procedure Committee; OB/Gyn Department; Patient
Care Policy & Procedure Committee; Medical Board

SIGNED BY

Ronald Sliwinski
President and CEO

J. Scott McMurray, MD
Chair, Patient Care Policy and Procedure Committee