14. Risk factors in this pregnancy Definitions Instructions Sources Key words/Abbreviations See above ART: Assisted reproductive i Pregnancy resulted from – any assisted reproductive technology technology Artificial insemination AIH: artificial insemination by husband In-vitro fertilization embryo transfer GIFT: gamete intrafallopian transfer ZIFT: zygote intrafallopian transfer Ovum donation, Sperm donation Donor embryo Embryo adoption 1st Prenatal Care Record under j - Mother had a previous C/S -- cesarean section If the mother has had a previous Past pregnancy history Repeat C/S cesarean delivery (CS) Past OB history Cesarean delivery, indicate the VBAC vaginal delivery after – Problem list or—initial number of previous cesarean Previous delivery by extracting cesarean risk assessment the fetus, placenta, and deliveries she has had. LSTCS (or LTCS) low membranes through an incision in segment transverse cesarean Do not count current 2nd Labor and Delivery Nursing the abdominal and section mother’s uterine walls pregnancy delivery Admission Triage Form Classical cesarean section under - Comments Low vertical cesarean section If yes, how many? Low transverse cesarean 3rd Admission H&P under After entering the number of section previous CS select the Past OB history If yes, please select the number of Past pregnancy history number of different types of each type of cesarean section Look for: under—problem CS from following list (total performed TOL trial of labor – list/findings should add up total number of k Anemia prior CS deliveries): See above. Hct hematocrit – – Hgb Hemoglobin – Hematocrit < 30 or Hemoglobin < Prior classical 10 (Vertical Uterine Incision) cesarean section Prior low transverse cesarean section
14. Risk factors in this pregnancy Definitions Instructions Sources Key words/Abbreviations i – Pregnancy resulted from any assisted reproductive technology See above ART: Assisted reproductive technology Artificial insemination AIH: artificial insemination by husband In-vitro fertilization embryo transfer GIFT: gamete intrafallopian transfer ZIFT: zygote intrafallopian transfer Ovum donation, Sperm donation Donor embryo Embryo adoption j - Mother had a previous cesarean delivery (CS) Previous delivery by extracting the fetus, placenta, and membranes through an incision in the mother’s abdominal and uterine walls If yes, how many? If yes, please select the number of each type of cesarean section performed If the mother has had a previous Cesarean delivery, indicate the number of previous cesarean deliveries she has had. Do not count current pregnancy delivery After entering the number of previous CS select the number of different types of CS from following list (total should add up total number of prior CS deliveries): Prior classical (Vertical Uterine Incision) cesarean section Prior low transverse cesarean section 1st Prenatal Care Record under Past pregnancy history Past OB history Problem list or—initial risk assessment 2nd Labor and Delivery Nursing Admission Triage Form under - Comments 3rd Admission H&P under Past OB history Past pregnancy history under—problem list/findings C/S -- cesarean section Repeat C/S VBAC – vaginal delivery after cesarean LSTCS (or LTCS) low segment transverse cesarean section Classical cesarean section Low vertical cesarean section Low transverse cesarean section Look for: TOL – trial of labor k – Anemia Hematocrit < 30 or Hemoglobin < 10 See above. Hct – hematocrit Hgb – Hemoglobin
Guide_MPM_BC_Facility_Worksheet_Guidelines.10.14.docx