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ZCMC

OB-GYNE NOTES
Admitting orders
Table of Contents
Sides Notes .................................................................. 1
Direct to DR ................................................................. 2
Direct to DR (Preeclampsia - in labor)........................ 3
Post-Partum Orders (PPO).......................................... 4
Post-Partum Orders (PPO-Preeclampsia) .................. 5
Post D&C ..................................................................... 6
Retained/Incarcerated Placenta ................................ 7
Preeclampsia - not in labor ........................................ 8
Oligohydramnios......................................................... 9
Premature Rupture of Membrane ........................... 10
Pre-term .................................................................... 11
Placenta Previa Preterm ........................................... 12
Missed Abortion / Unembryonic pregnancy ........... 13
Threatened Abortion (Septic)................................... 14
Threatened Abortion (Non-septic)........................... 15
Imminent / Inevitable Abortion ............................... 16
Incomplete Abortion (Septic) ................................... 17
Incomplete Abortion (Non-Septic) ........................... 18
Cesarean Section ...................................................... 19
Eclampsia .................................................................. 20
Sides Notes
Date:
Time:

BP:
LMP:
AOG:
EDC:
FH:
FHT:
IE: Cervix: __ cm dialated; ___% effaced
( ) BOW; Station ___
Presentation: ______

Impression: G_P_ (____); PU; ___ weeks AOG by


_____; ______ IL

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Direct to DR
Direct to DR
Secure consent
NPO
Start IVF w/ D5LR 1L to run at 20gtts/min
LABS:
o CBC plt, Blood typing
o UA
o HBsAg
Monitor FHT q15mins, record please
Monitor VS q1hr
Perineal prep please
Refer accordingly

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Direct to DR (Preeclampsia - in labor)
Direct to DR
Secure consent
NPO
Start IVF w/ D5LR 1L to run at 20gtts/min
SD with D5W 500cc +10g MgSO4 at 20gtts/min
LABS:
o CBC plt, Blood typing
o UA
o HBsAg
o FBS, BUN, Crea,
o SPOT, SGPT
o Serum K
o CXR PA with abdominal shield enroute to DR
o ECG 12 leads
o Baseline CTG
MEDS:
o Hydralazine 5mg IVT PRN for BP
160/100mmHg
o MgSO4 4g IV bolus now
Monitor FHT and VS q15 mins, record please
Perineal prep please
Refer accordingly

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Post-Partum Orders (PPO)
To ward 1
DAT
Oxytocin 10 IU IM
Incorporate Oxytocin to present IVF at 1:100
dilution to run at 20gtts/min then IVF to consume
if no active bleeding
MEDS:
o Cefadroxil 500 mg CAP; 1 cap BID for 7 days
(for clear meconium)
o Cefuroxime 500 mg CAP; 1 cap BID for 7 days
(for thin to thick meconium)
o Metronidazole 500 mg TAB; 1 tab TID for 7
days (for mod to thick meconium)
o Mefenamic acid 50 0mg TAB; 1 tab TID PRN for
pain
o MV + Iron TAB; 1tab OD
Monitor VS q15 mins x 1 hr, then q30 mins x 1 hr,
then 1 hr until stable, then q4 hr once stable
WOF profuse bleeding and other unusual events
Refer accordingly

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Post-Partum Orders (PPO-Preeclampsia)
To ward 1
DAT
Oxytocin 10 IU IM
Incorporate Oxytocin to present IVF at 1:100
dilution to run at 20gtts/min then IVF to consume
if no active bleeding
SD with D5W 500cc +10g MgSO4 at 20gtts/min
MEDS:
o Cefadroxil 500 mg CAP; 1 cap BID for 7 days
(for clear meconium)
o Cefuroxime 500 mg CAP; 1 cap BID for 7 days
(for thin to thick meconium)
o Metronidazole 500 mg TAB; 1 tab TID for 7
days (for mod to thick meconium)
o Mefenamic acid 500 mg TAB; 1 tab TID PRN for
pain
o MV + Iron TAB; 1tab OD
o Amlodipine 10mg TAB; 1 tab OD at AM
o Losartan 50 mg TAB; 1 tab OD at HS
o Clonidine 75 mg TAB; 1 tab SL PRN for BP
160/100 mmHg
Monitor VS q15 mins x 1 hr, then q30 mins x 1 hr,
then 1 hr until stable, then q4 hr once stable
Insert FBC
I & O q4hr
WOF profuse bleeding and other unusual events
Refer accordingly

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Post D&C
To ward 1
DAT once fully awake
Oxytocin 10 IU IM
Incorporate Oxytocin to present IVF at 1:100
dilution to run at 20gtts/min then IVF to consume
if no active bleeding
SD with D5W 500cc +10g MgSO4 at 20gtts/min
MEDS:
o Cefadroxil 500 mg CAP; 1 cap BID for 7 days;
OR Clindamycin 500 mg CAP; 1 cap TID for 7
days
o Mefenamic acid 500 mg TAB; 1 tab TID PRN for
pain
o MV + Iron TAB; 1tab OD
o Methylergonometrine 1amp IVT now then 1
tab TID x 3 days
Monitor VS q15 mins x 1 hr, then q30 mins x 1 hr,
then 1 hr until stable, then q4 hr once stable
WOF profuse bleeding and other unusual events
Refer accordingly

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Retained/Incarcerated Placenta
Please admit patient to ward 1
Secure consent
NPO temporarily
Start IVF w/ D5LR 1L to run 200cc as fast drip then
incorporate oxytocin 1:100 dilution at 20gtts/min
LABS:
o CBC plt, Blood typing
o UA
o HBsAg
MEDS:
o Cefuroxime 1.5 g IVT now then 750 mg IVT
q8hr ( ) ANST
o Metronidazole 500 mg IVT now then q8 hr
o Mefenamic acid 50 0mg TAB; 1 tab TID PRN for
pain
o MV + Iron TAB; 1tab OD
o Methylergonometrine 1amp IVT now then 1
tab TID x 3 days
Monitor VS q15 mins x 1 hr, then q30 mins x 1 hr,
then 1 hr until stable, then q4 hr once stable
WOF profuse bleeding and other unusual events
Refer accordingly

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Preeclampsia - not in labor
Please admit patient to ward 1
Secure consent
NPO temporarily, except meds
Start IVF w/ D5LR 1L to run at 20gtts/min
SD with D5W 500cc + 10g MgSO4 at 20gtts/min
LABS:
o CBC plt, Blood typing
o UA
o HBsAg
o FBS, BUN, Crea,
o SPOT, SGPT
o Serum K
o CXR PA with abdominal shield
o ECG 12 leads
o Baseline CTG
MEDS:
o Hydralazine 5mg IVT PRN for BP
160/100mmHg
o Methyldopa 250mg TAB; 1 tab q6hr PO
o MgSO4 4g IV bolus now
o (if term) HNBB 1amp IVT now then q1hr x 2
more doses
Monitor FHT, VS and POL q2hrs, record please
Insert FBC & attach to urobag
I&O q1hr, record please
Perineal prep please
Refer accordingly

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Oligohydramnios
Please admit patient to ward 1 (IMU)
Secure consent
DAT; NPO once in labor
Start IVF w/ D5LR 1L to run 300cc as fast drip then
regulate at 20gtts/min
LABS:
o CBC plt, Blood typing
o UA
o HBsAg
o Pelvic UTZ c/o Dr. Yu
MEDS:
o HNBB 1amp IVT now then q1hr x 2 more doses
O2 inhalation via nasal cannula at 3-5LPM
Position at left lateral decubitus
Monitos VS, FHT & POL q2hr, record please
Perineal prep please
Refer accordingly

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Premature Rupture of Membrane
Please admit patient to ward 1 (IMU)
Secure consent
DAT; NPO once in labor
Start IVF w/ D5LR 1L to run at 20gtts/min
LABS:
o CBC plt, Blood typing
o UA
o HBsAg
MEDS:
o Cefuroxime 1.5 g IVT now then 750 mg IVT
q8hr ( ) ANST
o (if term) HNBB 1amp IVT now then q1hr x 2
more doses
Monitos FHT & POL q1hr, record please
Monitor VS q4hr, record please
Nipple stimulation
Awaits vaginal delivery
Perineal prep please
Refer accordingly

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Pre-term
Please admit patient to ward 1 (IMU)
Secure consent
NPO temporarily
Start IVF w/ D5LR 1L to run 500cc as moderate
fast drip then regulate at 30gtts/min
LABS:
o CBC plt, Blood typing
o UA
o HBsAg
o Pelvic UTZ c/o Dr. Yu
MEDS:
o Isoxsuprine drip (SD but with no loading of
mainline): D5W 500cc + Isoxsuprine 4amps to
run at 20ugtts/mins & increase titration
5ugtts/min q20mins to a max of 60ugtts/min if
there are ongoing uterine activity or evidence
of further cervical dilation; OR
o MgS04 drip (SD but with no loading of
mainline): D5W 1L + MgSO4 10mg to run at
20gtts/min
o (24-34wks) Dexamethasone 6mg IM now then
q12hr x 3 more doses
Monitos FHT & POL q1hr, record please
Monitor VS q4hr, record please
Nipple stimulation
Awaits vaginal delivery
Perineal prep please
Refer accordingly

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Placenta Previa Preterm
Please admit patient to ward 1 (IMU)
Secure consent
NPO temporarily
Start IVF w/ D5LR 1L to run at 30gtts/min
SD with D5W 500cc + 10g MgSO4 at 20gtts/min
LABS:
o CBC plt, Blood typing
o UA
o HBsAg
MEDS:
o (24-34wks) Dexamethasone 6mg IM now then
q12hr x 3 more doses
o Cefuroxime at bedside
Secure 1unit of PRBC properly typed and
crosmatched
WOF profuse vaginal bleeding
CBR w/o BRP
Monitos FHT & VS q1hr, record please
Perineal prep please
Refer accordingly

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Missed Abortion / Unembryonic pregnancy
Please admit patient to ward 1
Secure consent
NPO
Start IVF w/ D5LR 1L to run at 30gtts/min
LABS:
o CBC plt, Blood typing
o UA
o HBsAg
MEDS:
o Cefuroxime 1.5 g IVT now then 750 mg IVT
q8hr ( ) ANST
o HNBB 1amp IVTT now then q1 hr x 2 more
doses
Monitor VS q4 hrs, record please
WOF profuse bleeding or passage of products of
conception
For D&C on call
Refer accordingly

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Threatened Abortion (Septic)
Please admit patient to ward 1
Secure consent
Low residue diet
Start IVF w/ D5LR 1L to run at 30gtts/min
LABS:
o CBC plt, Blood typing
o UA
o HBsAg
o CXR PA with abdominal shield
o Blood & urine GS/CS
o Gram stain of vaginal discharge
o TVS UTZ (if 12 weeks)
MEDS:
o Cefuroxime 1.5 g IVT now then 750 mg IVT
q8hr ( ) ANST
o Metronidazole 500 mg IVT now then q8 hr
o Paracetamol 300mg IVT q 4hrs PRN for fever >
37.8
CBR without BRP
Perineal prep please
Monitor FHT and VS q4 hrs
Refer accordingly

Alternative for Cefuroxime:


o Penicillin G Na 5M U IVT q6 hrs ( ) ANST
o Ampicillin 2g IVT now then 1g IVT q6hr ( ) ANST

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Threatened Abortion (Non-septic)
Please admit patient to ward 1
Secure consent
Low residue diet
Start IVF w/ D5LR 1L to run 300cc as moderate
fast drip then regulate at 30gtts/min
LABS:
o CBC plt, Blood typing
o UA
o HBsAg
o TVS UTZ (if 12 weeks)
MEDS:
o Isoxsuprine drip (SD but with no loading of
mainline): D5W 500cc + Isoxsuprine 4amps to
run at 20ugtts/mins & increase titration
5ugtts/min q20mins to a max of 60ugtts/min if
there are ongoing uterine activity or evidence
of further cervical dilation; OR
o MgS04 drip (SD but with no loading of
mainline): D5W 1L + MgSO4 10mg to run at
20gtts/min
CBR without BRP
Monitor FHT and VS q4 hrs
Refer accordingly

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Imminent / Inevitable Abortion
Please admit patient to ward 1
Secure consent
NPO temporarily
Start IVF w/ D5LR 1L (if inevitable, + oxytocin 10
IU) to run at 20gtts/min
LABS:
o CBC plt, Blood typing
o UA
o HBsAg
o TVS UTZ (if 12 weeks)
MEDS:
o Cefuroxime 1.5 g IVT now then 750 mg IVT
q8hr ( ) ANST
Refer to ROD if with passage of abortus or meaty
tissue
For completion curettage once with passage of
products of conception
Monitor VS q4 hrs, record please
WOF profuse bleeding or passage of products of
conception
Perineal prep please
Refer accordingly

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Incomplete Abortion (Septic)
Please admit patient to ward 1
Secure consent
NPO temporarily
Start IVF w/ D5LR 1L + oxytocin 10 IU to run at
20gtts/min
LABS:
o CBC plt, Blood typing
o UA; HBsAg
o CXR PA upright
o Blood & urine GS/CS
o Gram stain of vaginal discharge
MEDS:
o Cefuroxime 1.5 g IVT now then 750 mg IVT
q8hr ( ) ANST
o Metronidazole 500 mg IVT now then q8 hr
o Paracetamol 300mg IVT q4hrs PRN for fever
>37.8
o TT 0.5mL IM
o ATS 3000 IU IM ( ) ANST
For completion curettage on call
Secure consent for completion curettage
Inform DR
Monitor VS q1 hrs, record please
Perineal prep please
Refer accordingly

Alternative for Cefuroxime:


o Penicillin G Na 5M U IVT q6 hrs ( ) ANST
o Ampicillin 2g IVT now then 1g IVT q6hr ( ) ANST
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Incomplete Abortion (Non-Septic)
Please admit patient to ward 1
Secure consent
NPO temporarily
Start IVF w/ D5LR 1L + oxytocin 10 IU to run at
20gtts/min
LABS:
o CBC plt, Blood typing
o UA
o HBsAg
MEDS:
o Cefuroxime 1.5 g IVT now then 750 mg IVT
q8hr ( ) ANST
For completion curettage on call
Secure consent for completion curettage
Inform DR
Monitor VS q4 hrs, record please
Perineal prep please
Refer accordingly

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Cesarean Section
Please direct to OB-OR
Secure consent
NPO
Start IVF w/ D5LR 1L to run at 30gtts/min
LABS:
o CBC plt, Blood typing
o UA
o HBsAg
MEDS:
o Cefuroxime 1.5 g IVT ( ) ANST on call to OB-OR
then 750 mg IVT q8h
For (STAT or DIRECT) (Primary or Repeat) LTCS;
Indication: __________
Secure consent for LTCS
Inform COC/SROC
Inform OB-OR/Anes/Pedia ROD
Perineal Prep please
Monitor FHT q1hr, record please
Monitor VS q4hrs, record please
(if repeat LTCS) Secure 1unit of PRBC properly
typed & crossmatched for possible OR use
Refer accordingly

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Eclampsia
Call ROD Immediately (Emergency measures:
O2 inhalation, tongue depressor, suction secretions)

Please direct to OB-OR


Secure consent
NPO
Start IVF w/ D5LR 1L to run at 20gtts/min
SD with D5W 500cc + 10g MgSO4 at 20gtts/min
LABS:
o CBC plt, Blood typing
o UA; HBsAg
o FBS, BUN, Crea, SPOT, SGPT Serum K
o CXR PA with abdominal shield
o ECG 12 leads
MEDS:
o Hydralazine 5mg IVT PRN for BP
160/100mmHg
o MgSO4 4g IV bolus now
o Cefuroxime 1.5 g IVT now then 750 mg IVT
q8hr ( ) ANST
Insert FBC & attach to urobag
Monitor FHT and VS q15mins, record please
Monitor I&O q1hr, record please
For direct to OR for LTCS for deteriorating
maternal status secondary to eclampsia
Secure consent for LTCS
Inform COC/SROC
Inform OB-OR/Anes/Pedia ROD
Refer accordingly

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