newborn babyMATERNITY GUIDE
UTHSCSA Family & Community Medicine Dept.
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WARDS
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ANTEPARTUEM PEARLS

  • Gestational Hypertension: Deliver at term for favorable cervix (Bishop score of >/= 4), severe preeclampsia or 40 6/7 weeks)

  • Chronic Hypertension: Deliver at term for favorable cervix (Bishop score of >/= 4), severe preeclampsia or 40 6/7 weeks)

  • Preeclampsia: Deliver at term for favorable cervix (Bishop score of >/= 4), severe preeclampsia, or 40 6/7 weeks), <37 weeks – bedrest, BP Q 6h, Protein Qam, PIH labs Q 3days, NST 2x /wk

  • Severe Preeclampsia:
    • Preterm: Admit to L&D for evaluation, if improved expectant mgmt, if no
         improvement…Deliver
    • Term:  Deliver
  • Superimposed Preeclampsia on Chronic Hypertension: Deliver

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OB WARDS
Patient will go home after 24 hours if desired (if afebrile and uncomplicated labor course) unless fits into below categories:

Patient will stay 48 hours IF:

  • 1st time mom
  • Teen
  • Breastfeeding for first time
  • Pre-eclamptic/Eclamptic
  • GBS +/unknown (if doesn't want to leave w/o baby)
  • On Abx - until afebrile 48 hours and culture negative; if chorio with blood cx positive - stays for 7d (or arrange for home IV antibiotics with Midori)
  • 3º/4º MLE until has BM

Postpartum Rounds: Notify team if complications:  DVT, prolonged fever, increased BP 3rd and 4th degrees need BM and suture check prior to discharge home and Surfak for at least 4 weeks.

Management for C-section:

POD# 1:
  • Remove the bandage (chief dependent)
  • Discontinue Foley
  • Clear liquids as tolerated
  • Ambulate TID, OOB
    • When taking po well:
      • Heplock IV
      • Vicodin 1-2 tablets po q 4-6hrs prn pain
      • Simethicone 80mg po QID
      • If no BM by D#3: MOM 30ml po q 6hrs until BM
             Surfak 240mg po bid/ Dulcolax 1 tablet supp pr Q4h (optional)
      • Motrin 800mg po TID
POD# 2:
  • Regular diet as tolerated
POD# 3-4:
  • Remove staples and place steri-strips if Pfannenstiel incision
POD# 5-7:
  • Remove staples and place steri-strips if midline incision
POD# 8-10:

  • Remove staples and place steri-strips if midline incision carried above umbilicus
When patient has had temp less than 99.9 for 48 hours, and all is well she may be discharged to home.

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