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

Page | 1
 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

Page | 2
 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

Page | 3
 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

Page | 4
 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

Page | 5
 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

Page | 6
 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

Page | 7
 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

Page | 8
 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

Page | 9
 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

Page | 10
 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

Page | 11
 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

Page | 12
 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

Page | 13
 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

Page | 14
 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

Page | 15
 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

Page | 16
 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
Page | 17
 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

Page | 18
 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

Page | 19
 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

Page | 20