By now you should know about the lists we have on Listrunner - there are 4...plus 1
- This is a list of all of the NHC patients are high risk - basically if they aren't low risk, they are high risk (except history of normal section, history of GDM, history of preeclampsia). Some of the following people should ABSOLUTELY be included on the list (and note the things to make sure you discuss or add to their initial visit)
- Advanced maternal age (>35 years old at delivery) - should offer EVERY last one of them referral to MFM for genetic screening (will be out of pocket for self pay patients). If declines this, then make sure that they are offered Quad screen
- Teen Pregnancy (<18yo should be on the list) - plan to see social work each trimester and on admission to the hospital
- Grand Multiparity (5+ deliveries, not 5+ pregnancies) - plan to have cytotec in the delivery room (plus methergine if history of PPH, or if this will be delivery 10+)
- Hypertension in Pregnancy - cHTN (assess need for meds, make sure you get baseline Cr/AST/ALT/p:c ratio, and start ASA 81mg daily at 12 weeks); if gHTN or preeclampsia, get full PIH panel, get growth scan (and do Q4W), and start twice weekly antenatal testing with twice weekly BP checks. Consider MFM referral
- Diabetes in Pregnancy - DM2 (assess control and see weekly until controlled, get baseline Cr/AST/ALT/p:c ratio, and start ASA 81mg daily at 12 weeks); if GDM can give them 1 week to try diet control, but follow close (weekly) until controlled and can then space out.
- History of PPROM or spontaneous PTD - should get as much info as you can about what happened and what was felt to be responsible. Discuss transvaginal cervical length screening (every 2 weeks from 16-28 weeks) and weekly progesterone injections (from 16-36 weeks). If no insurance, there are affordable options for progesterone injections.
- History of recurrent miscarriages - should have at least 3 to get on this list. Can start on some ASA 81mg and refer to MFM for work-up
- History of/Ongoing Substance Use Disorder - get UDS, add HCV Ab to prenatal labs. Assess for needing Buprenorphine/Methadone and refer to appropriate place for this. Assess for need for inpatient treatment (A Mother's Hope, Hope House, Transitions/YWCA). Refer to counselling (see the flow sheet in the Quick Reference Materials)
- Multiple Gestation - refer to MFM and start on ASA 81mg at 12 weeks. Get baseline AST/ALT/Cr/p:c ratio with prenatal labs. Would get 24 week GTT. If declines MFM, needs Q4W US from 16 weeks for growth, and start 1-2 times a week BPP.
- Abnormal Growth - macrosomia or IUGR; should have Q3 week US with dopplers if IUGR, and should be on twice weekly antenatal testing from diagnosis. Macrosomia should be followed with Q4W growth scans, and consider repeating GTT
- Poly/Oligohydramnios - if oligo should hydrate and repeat with BPP in 2-3 days (and with strict return precautions)
- Placenta Previa - marginal (within 2cm of the cervical os) or complete (covering the cervical os)....should be diagnosed and followed by a TRANSVAGINAL ULTRASOUND ONLY!!!! Patients should be put on pelvic rest (nothing in the vagina), and should repeat US in 4-6 weeks to see if has resolved
- History of DVT - should be on ASA or lovenox. Figure out why (provoked or unprovoked) and make sure a w/u was done. Refer to MFM
- Pyelonephritis in pregnancy - should be on nightly prophylaxis through the rest of pregnancy
- Lupus, hypo/hyperthyroid/thrombocytopenia/Hep B/Hep C/HIV/Syphilis.....any other medical issues that could potentially affect the pregnancy
- Every one of your OBs through the FMC should be on this, and you should ideally be editing it within 48 hours of seeing the patient (and as ultrasounds and labs come back to you)
- HCGs, cultures, etc
- Interns are responsible for following this list
- Should be reviewed at least 2-3 times a week, and updated as needed
- All the patients currently on the NHC service will be on this list.
- Keep the list updated, and get rid of the useless information that is no longer pertinent (ie. cervical checks, etc)
- If patient is a triage and is part of the high-risk list, make sure that you don't discharge them from the high risk list when you take them off the inpatient list.
- You do not want to be on this list.
- May be stratified into first, second, and third degree Murder Lists depending on your offenses
- Ask Dr. Maertin and Dr. Tatara about this if you need more information