Management of Labor. Management of Critical Event Algorithm.

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Source: Institute for Clinical Systems Improvement (ICSI). Management of labor. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2007 Mar. 72 p. Management of Labor Management of Critical Event Algorithm Patient has critical event A = Annotation Cervix 5 plus cm dilated? A Initial dose betamethasone STAT and plan for delivery. A Safe to transfer or transport mother before birth? Prepare for preterm delivery/neonatal transport Chorioamnionitis suspected? Broad spectrum antibiotics. A Plan for delivery *Stabilize on MgSO4 (tocolytics). *Transfer mother to appropriate level of care if possible. A *Stabilize on MgSO4 (tocolytics). *Transfer mother to appropriate level of care if possible. A Bethamethasone 23-34 weeks. A Sonogram for: *Amniotic fluid index (AFI). *Presentation/placentation. *Follow-up level II as indicated Sonogram detects gross anomaly? Fetal anomaly compatible with life? Await spontaneous labor Possibly initiate tocolytics, betamethasone and antibiotic group B strep (GBS) prophylaxis. A ROM? Vaginal pool plus or minus amnio at 32+ weeks for fetal lung maturity (FLM). A Deliver for: *Disseminated intravascular coagulation (DIC). *FLM. *Fetal distress. *Nonreassuring FHT. *Significant bleeding. Management of preterm labor with bleeding. A Vaginal bleeding? Consider amniocentesis at 34 weeks for FLM Deliver for: *Eventual FLM. *Fetal distress. *Chorioamnionitis. *Active labor. *37 weeks no PROM. *37 weeks PROM. *Other obstetrical indicators. A Fetal lung maturity (FLM) study positive? Preterm delivery All copyrights are reserved by the Institute for Clinical Systems Improvement, Inc.