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Guidelines
Upcoming Conferences

10/20/2014  @ DHMC
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The following guidelines are intended only as a general educational resource for hospitals and clinicians, and are not intended to reflect or establish a standard of care or to replace individual clinician judgment and medical decision making for specific healthcare environments and patient situations.

Definitions:

Elective Induction: Induction of labor without clear medical benefit to mother or child for delivery at that point in time compared with continuation of pregnancy.

Medically Indicated Induction: Induction of labor when there is clear medical benefit to either mom or baby from ending the pregnancy rather than continuing it.

Labor: Painful and regular contractions with progressive cervical change.

Downloadable Documents

Elective Labor Induction Guidelines
 
INTRODUCTION

From 1990 to 2006, the national rates of induction of labor have doubled to approximately 22.5% (1). In 2010, many NNEPQIN member hospitals reported overall rates of induction of labor of 28-32%.

The benefits of labor induction must be weighed against the potential maternal and fetal risks associated with this procedure (2). The induction of labor may increase the likelihood of neonatal complications or result in unnecessary cesarean section. These risks may be necessary to assume in complicated pregnancies, in which prolongation of gestation presents further risk to the mother or fetus.

Prior to initiating the induction, the patient should be counseled about the indications for induction, the agents and methods to be employed, and the risks of failure, cesarean delivery, or fetal compromise.

A physician capable of performing cesarean section should be readily available during the induction of labor (3).

Downloadable Documents:

NNEPQIN Medical Indicated IOL
NNEPQIN Cervical Ripening Guideline
Obesity

Every pregnant woman wants to take the best care of her growing baby. Women who are overweight and obese during pregnancy need to take special care to have a healthy pregnancy. Obesity is defined as a body mass index (BMI) over 29 kg/m2. Your BMI is _____ kg/m2. Being obese during pregnancy has risks that we want you to know about. We donít give you this information to scare you. We know that achieving a healthy weight when you are obese is hard and that many women start pregnancy being obese. We believe in giving you honest, accurate information so that we can work together to help you have the healthiest pregnancy and baby possible.

Downloadable Documents:

NNEPQIN Obesity and Pregnancy Patient Education
Obese Patient Guideline
Emergency Cesarean Section

At the September meeting of 2003, NNEPQIN members decided to devote the upcoming year to improving Emergenecy Cesarean Deliveries. We chose to use an approach that involved process mapping, identifying critical steps and resources, simulation exercises, and tracking of outcomes. We thus created a tool kit for hospitals to use to improve their local emergency cesarean delivery process. The documents listed below were created during the two meetings and were finalized at our Spring 2004 meeting. NNEPQIN subsequently recieved an ACOG Wyeth Ayerst award in recognizing the excellence of this work. NNEPQIN hopes you find these documents useful and we welcome all comments and suggestions aimed at improving this body of work.

Downloadable Documents:

Simulation Task Evaluation Tool
Simulation Planning Guide
Outcomes Tracking Debriefing tool
Global process overview
Emergency cesarean tray
Emergency cesarean guideline
Drill Defriefing
Perinatal HIV Resources

HIV is transmitted to newborns at the time of delivery and through breast feeding. Optimal treatment during pregnancy, delivery and infancy reduced the risk of a child acquiring HIV from 25% to less than 2%. Optimal treatment is contingent upon prenatal screening for HIV. Currently, ~40% of children who acquire HIV are born to women who did not undergo screening in pregnancy.

The Centers for Disease Control and Prevention and the American College of Obstetrics and Gynecology recommend routine screening for HIV during pregnancy with opt out consent. All women are told that an HIV test is recommended and will be performed unless they refuse.

Opt out consenting has proven in multiple studies to be the most effective means of screening pregnant women and preventing transmission to their children.

Listed below are documents prepared in 2006 and 2007 by NNEPQIN to facilitate HIV testing during pregnancy. They represent our collective interpretation of the current scientific evidence and published guidelines. We anticipate that these documents will be modified by institutions to reflect their local processes and standards of care. Each institution is responsible for validating these documents and any modifications.

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Useful Links:

The ACOG website below has many resources regarding testing and care of both the pregnant and non-pregnant HIV Patient: http://womenandhiv.org

CDC testing recommendations: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm

CDC rapid HIV testing resources: http://www.cdc.gov/hiv/topics/testing/rapid/index.htm

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NEW PATIENT RESOURCES to the BAPAC. Please clink on the following link to access them:
http://hiv.ucsf.edu/care/perinatal/resources.html

The two videos are

1. Timed Intercourse for the HIV- Female/HIV + Male couple
2. Timed Intercourse and home insemination for the HIV+ Female/HIV- Male couple

The PDFs are:

1. Home insemination (with photos) for the HIV + Female/HIV Male couple seeking conception
2. Comprehensive review of safer conception options for HIV + Male/HIV Female couples
3. Comprehensive review of safer conception options for HIV + Female/HIV male couples
4. Is PrEP right for you, a primer for HIV- women considering PrEP for HIV prevention
5. PRO MEN (Positive Reproductive Outcomes for Men) Thinking about having a baby? for HIV+ men who have sex with women
6. PRO MEN (Positive Reproductive Outcomes for Men) Thinking about having a baby? for HIV- women with an HIV+ male partner



Downloadable Documents:

Letter to Senator
HIV testing flow sheet
HIV Consent Form 2
 
Trial of Labor After Cesarean Delivery (VBAC)

After cesarean section, a woman may choose to have a planned cesarean birth or choose a trial of labor for vaginal birth. It is likely that 60-80% of women who try a vaginal birth after cesarean section (VBAC) will be successful. We want you to understand the benefits and risks of your choices. There is risk that goes along with every pregnancy. We share the same goal as you: a healthy baby delivered to a healthy mom. We will make every effort to ensure this.

Downloadable Documents:

NNEPQIN VBAC Patiient Education
NNEPQIN VBAC Guideline revised
NNEPQIN VBAC Consent
 
Home Birth


Downloadable Documents:

Murmuration of Midwives
Home Birth to Hospital Transfer Form
 
Confidential Review & Improvement Board (CRIB)

NNEPQIN CRIB Mission:

The NNEPQIN Confidential Review and Improvement Boards (CRIB) mission is to provide an in-depth, multidisciplinary analysis of unanticipated perinatal outcomes as part of a comprehensive, region-wide, patient safety agenda designed
to support learning from systems failures. Ultimately we hope to improve assessment for, and anticipation & prevention of, adverse perinatal events. The review process is available for NNEPQIN member hospitals and home birth providers that want to supplement their internal perinatal quality assurance program with a regional case review process. A single case or a series of cases may be appropriate for review. (Hospitals and home birth providers will herein be referred to as organizations.)

Please review the following documents for more info.

Downloadable Documents:

CRIB Business Associate Agreement
CRIB Submission Checklist
CRIB Operating Principles
 
Electronic Fetal Monitoring

The following guidelines are intended only as a general educational resource for hospitals and clinicians, and are not intended to reflect or establish a standard of care or to replace individual clinician judgment and medical decision making for specific

Downloadable Documents:

Electronic Fetal Monitoring Guidelines
 
Oxytocin Guidelines

The following guidelines are intended only as a general educational resource for hospitals and clinicians, and are not intended to reflect or establish a standard of care or to replace individual clinician judgment and medical decision making for specific healthcare environments and patient situations.

Downloadable Documents:

Use of Oxytocin Guidelines
 
Influenza

We are happy to share with you influenza materials developed by Dr. Laura Riley, Maternal Fetal Medicine and Infectious Disease specialist from Massachusetts General Hospital. They were forwarded to NNEPQIN through the ACOG District One Committee for Patient Safety. Please feel free to adopt them to your practice setting.

Downloadable Documents:

To all obstetric patients and new families
Nursery OB Influenza Guidelines Draft- 2013
Influenza Like Illness 2013
Flu Pregnancy Assessment and Treatment 2013
 
Substance Abuse in Pregnancy

These guidelines are for Substance Abuse in Pregnancy and Neonatal Abstinence Syndrome

Downloadable Documents:

NNEPQIN Guideline for the Management of Labor, Delivery and the Newborn in the Opioid Dependent Pregnancy
NNEPQIN Guideline for Screening for Use of Alcohol and Drugs Tobacco and Drugs of Abuse in Pregnancy
 
Second Stage Labor Management


Downloadable Documents:

 
Hypertension in Pregnancy


Downloadable Documents:

 
 

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