Pregnant Issues
The following are things that will require a Doctor visit to my collaborating physician. The following will risk you out of my care during pregnancy:
Anemia with hematocrit <30 and/or hemoglobin <10 at term
Bleeding: significant bleeding during second or third trimester
Blood coagulation defect
Blood pressure >140/90 which persists or rises and birth is not imminent, or chronic hypertension
Cancer, active
Cardiac disease
Chorioamnitis, suspected, during pregnancy and labor
Chronic Obstructive Pulmonary Disease
Congenital anomalies: major congenital anomalies of the newborn not diagnosed prenatally
Diabetes, insulin dependent or gestational diabetes, uncontrolled
DVT, acute or chronic during pregnancy and/or postpartum
Eclampsia at any point in pregnancy, labor, or postpartum
Ectopic pregnancy
Excessive vomiting, dehydration, or exhaustion unresponsive to treatment
Fetal demise
Fetal heart tones: abnormal cardiac rate or rhythm during pregnancy or labor
Fetal surveillance test with abnormal results (including but not limited to ultrasound, NST, BPP, etc)
FHT irregularities unresponsive to treatment
FHT unable to be auscultated
Hemoglobinopathies, history of
Hemorrhage, uncontrolled
Herpes: primary outbreak or active herpes lesion in a location that can not be covered during delivery
HIV/AIDS
Hyperthyroidism, uncontrolled
Infection requiring prescriptive therapy
Infection, signs of in the newborn
IUGR: during previous pregnancy
Laceration repair beyond the scope of the CDEM
Laceration or episiotomy that fails to heal or shows signs of breakdown and/or infection
Liver disease, severe
Malpresentation: suspected malpresentation during pregnancy or labor incompatible with vaginal delivery, unless birth is imminent
Maternal fever =/>100.4*f
Meconium, thick staining with non-reassuring FHT when birth is not imminent
Miscarriage: previous second trimester miscarriage
Multiple gestation, suspected
Ogliohydramnios, documented
Perinatal Mood Disorders or Psychosis, suspected or confirmed during pregnancy or postpartum
Persistent hypotonia, irritability, flaccidity, lethargy in the newborn
Placenta abruption (suspected, complete, or partial during pregnancy or labor)
Placenta previa (complete, marginal, or low lying) after 18wks gestation, suspected or confirmed in intrapartum
Platelet disorder, suspected
Polyhydramnios, documented
Postdates pregnancy lasting longer than 42wks gestation with an abnormal NST
Pre-eclampsia (at any point in pregnancy, labor, or postpartum)
Premature delivery: history of previous premature delivery <37wks gestation
Premature labor at <37wks gestation as documented by ultrasound (or clinically calculated due date if ultrasound unavailable)
Preterm/premature ROM <37wks gestation as documented by ultrasound (or clinically calculated due date if ultrasound unavailable)
Psychiatric disorders: severe psychiatric disorders requiring hospitalization or the the use of medications known to have adverse effects
Renal disease, severe
Respiratory distress, persistent in the postpartum
Retained placenta
Rh or other blood group isoimmunization
Seizure disorder requiring medication
Shock, maternal
Spontaneous abortion, incomplete
Subinvolution of the uterus
Substance abuse, current/active and known to cause adverse effects
Two vessel cord
Uterine ablation or anomaly
Uterine rupture, suspected
Uterine surgery: prior cesarean, uterine surgery with fundal incision, and/or myomectomy
Vital signs unstable