1st Prenatal Care Record under Check box yes or no Look for designation in maternal p. Intrauterine Growth Problem list or—initial record of: Restriction (IUGR) IUGR is diagnosed before risk assessment Poor fetal growth delivery Complications Fetal growth restriction Or Fetal Growth restriction IUGR 2nd Labor and Delivery Nursing Estimated fetal weight < 10th Fetus with an estimated fetal The term size less than dates may Admission Triage Form percentile weight less than the 10th be used to describe the uterine size under Fetal abdominal percentile for gestational age but is not enough to define fetal Admission chief circumference < 10th as determined by prenatal growth restriction. complaint percentile ultrasound. Comments Abnormal fetal Doppler Medications If the term small for gestational studies age (SGA) is used in maternal 3rd Admission H&P under record and describes the fetus Admission chief before birth then can be used to complaint designate IUGR Current pregnancy history Problem list/findings Not determined after birth when 4th Delivery Record under the weight is less than baby’s Maternal OB/labor the 10th percentile this is small – summary for gestational age (SGA) Labor and delivery admission history Labor summary record *Not found in newborn record
p. Intrauterine Growth Restriction (IUGR) Or Fetal Growth restriction Fetus with an estimated fetal weight less than the 10th percentile for gestational age as determined by prenatal ultrasound. Check box yes or no IUGR is diagnosed before delivery The term size less than dates may be used to describe the uterine size but is not enough to define fetal growth restriction. If the term small for gestational age (SGA) is used in maternal record and describes the fetus before birth then can be used to designate IUGR Not determined after birth when the baby’s weight is less than the 10th percentile – this is small for gestational age (SGA) 1st Prenatal Care Record under Problem list or—initial risk assessment Complications 2nd Labor and Delivery Nursing Admission Triage Form under Admission chief complaint Comments Medications 3rd Admission H&P under Admission chief complaint Current pregnancy history Problem list/findings 4th Delivery Record under Maternal OB/labor summary Labor and delivery admission history Labor summary record *Not found in newborn record Look for designation in maternal record of: Poor fetal growth Fetal growth restriction IUGR Estimated fetal weight < 10th percentile Fetal abdominal circumference < 10th percentile Abnormal fetal Doppler studies
Guide_MPM_BC_Facility_Worksheet_Guidelines.10.14.docx