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                  Pregnant Issues   

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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