4N Labor and Delivery
Cesarean Section Pre-Op orders (OB)
(Physician must sign all orders-check, circle and/or fill in appropriate
blanks)
Admit
1.
2.
3.
4.
5.
6.
7.
8.
Admit to:
L&D
4E
4S
4SMC
Attending: _______________, Beeper__________
Resident:_________________, Beeper__________
Team: _____________________
Diagnosis: Scheduled Cesarean section for _____@_____EGA
No Known Allergies
Enter Allergy: (drug, food, other)___________________________________________________
Notify house officer: T>: 100 T<: 95 SBP>: 140 SBP<: 90 DBP>: 95 DBP<: 50 HR>: 120 HR<: 50 RESP>: 24
RESP<: 10 UOP<: 120 ml/ 4h UOP w/Foley < 60ml/ 2h; if 02 sats <92% apply 02@ 2L NC and NHO for
altered mental status and pain score >7 with current meds
9. Nursing:
 Vital signs on admission and per unit standard following epidural insertion PER Unit on
admission and post-epidural per anesthesia
 Obtain reassuring FHR on admission; continuous EFM after regional anesthesia
 Confirm and update dating criteria for EGA
 Verify that consent form signed
 No routine pulse oximetry
 IV Start, adult per nurse
 Lidocaine 1% injection: 0.2 ml intradermal x1 (PRN anesthetic for IV start per patient
preference)
 Terbutaline Inj: Brethine 0.25 mg iv q2h prn (per protocol EFM/Toco indication)
 NPO daily until discharged
 Foley – Remove per discharge protocol: insert following initiation of regional analgesia;
discontinue 16 hrs. after cesarean section or when epidural is discontinued
 I&O strict
 Bedrest with BRP
 Hair removal with clippers or scissors only if indicated, do not shave
 Aromatic Ammonia Spirits Inhal: 1 ea inhalant prn (pre-syncopal/syncopal episode)
 Anesthesia Consult
 Draw one purple top tube and send to blood bank to hold for workup (T&S, T&C) if necessary
 Sequential Compression Device: off 1 hr q 8hr. Dept of OB/GYN recommends SCD’s for all pts
undergoing a C/S regardless of DVT and PE risk factors
 Order blood glasses if fetal compromise, 5 minute Apgar <7, severe IUGR, maternal thyroid
disease, abnormal fetal heart tracking, intrapartum fever, and/or multifetal gestations
1 of 4
Initials: _________
Date:______/_____/_____
Time: ____:______
4N Labor and Delivery
Cesarean Section Pre-Op orders (OB)
(Physician must sign all orders-check, circle and/or fill in appropriate blanks)

Fetal Cord blood gas Arterial x 1 (if indicated by L&D protocol)


Fetal Cord blood gas Venous x 1 (if indicated by L&D protocol)
Obtain acticoat moisture control silver dressing, to be placed post-operatively on all c-section
incisions unless Dermabond is used
Cord stat collection will hold cord segment in lab in the event drug screen indicated per peds provider.
10. Cord STAT Collection x1 (collection for peds provider)
Labs: if no prenatal labs order HIV, Hepatitis, RPR, T&S
Obtain rapid HIV if anticipating delivery soon and 3rd Trimester HIV testing unknown:
11. Rapid HIV L&D x1 pregnancy, hiv status unknown.

NURSING: Give Source Patient "Rapid HIV-1 Antibody Test Information Booklet" (print from e-docs)
If results are NOT needed immediately:
12. HIV 1&2 AB & P24 AG BY CIA x1
13. Hepatitis B Surf Antigen x1 ___
14. RPR qualitative blood
15. Type & screen(ABO/RH/ATBY SCN) _______x1
16. Blood bank misc sample x1 (one purple top tube to blood bank to hold for workup)
If evidence of infection
17. CBC / PLT CT / DIFF stat x1
If coagulopathy, thrombocytopenia, etc.
18. Platelet count bld stat x1
IV Fluids and Medications
19. LR: lactated ringers 125 ml/hr iv now
20. NS: sodium chloride 0.9% 125 ml/hr iv now
For Diabetic Patients
21. D5 1/2 NS: 125 ml/hr iv now (use an infusion pump to administer fluids at the rate of 125ml/hr)
2 of 4
Initials: _________
Date:______/_____/_____
Time: ____:______
4N Labor and Delivery
Cesarean Section Pre-Op orders (OB)
22. Blood glucose testing, OB Q2H
23. Blood
testing, OBcircle
Q1Hand/or
if glucose
is greater blanks)
than 110 mg/dl or on insulin infusion
(Physician
mustglucose
sign all orders-check,
fill in appropriate
+Regular human insulin inf: 1 units/hr iv now
-Infusion Instructions: “begin infusion for blood glucose greater than 110mg/dl on 2 consecutive
measurements”
-comments: notify pharmacy when bag is needed
Order Azithromycin on ALL patients PLUS the Cefazolin OR Penicillin alternative prophylaxis
24. Azithromycin injection: 500 mg iv x1 now (infuse over one hour. Complete prior to incision if able; for
unplanned c/s, do not delay procedure for this antbx dose.)
Consider treatment with antiemetic when administering Azithro
25. Ondansetron injection 4 mg iv x1 (for prevention of nausea/vomiting associated with Azithromycin admin)
PLUS
BMI is less than 30:
26. Cefazolin inj: ancef 1000 mg iv x1 (on call to O.R.)
BMI is 30 or greater:
27. Cefazolin inj: ancef 2000 mg iv x 1 (on call to OR)
If Penicillin allergic:
Patients with Penicillin allergy will receive azithromycin, gentamicin, and clindamycin (or vanc if allergic to
clindamycin)
28. Gentamicin inj: garamycin =w*1.5mg/kg mg iv x1 now (on call to or; may round to nearest 10mg. max dose
600mg)
PLUS
29. Clindamycin inj: cleocin 900 mg iv x1 (on call to O.R.)
OR
if allergy to clindamycin:
30. Vancomycin injection: 1000 mg iv x1 now (on call to O.R.)
AMTSL
31. oxytocin 15 units in ns 250 ml : pitocin 2 bag iv as dir (rate 125ml/hr x 4 hours; start after delivery of
*****baby (VUMC L&D Recommendation).)
32. oxytocin 15 units in ns 250 ml : pitocin 2 bag iv as dir (rate 125ml/hr x 4 hours; start after delivery of
***placenta.)
Select one if oxytocin is NOT ordered during third stage of labor:
3 of 4
Initials: _________
Date:______/_____/_____
Time: ____:______
4N Labor and Delivery
Cesarean Section Pre-Op orders (OB)
(Physician must sign all orders-check, circle and/or fill in appropriate blanks)
34. Post-procedure nursing orders: No oxytocin is ordered for this patient:



pt is low risk and no oxytocin is indicated x 1
no oxytocin is ordered for this patient upon transfer to floor: pt declines oxytocin
No oxytocin is ordered for this pt upon transfer to floor: other_______ x 1
If HIV positive:
35. Zidovudine infusion: AZT (2mg/kg loading dose over 1 hour, then 1 mg/kg/h until delivery)
36. Cesarean Section post-op orders (OB) (link to XOS=927)
37. Postpartum Hemorrhage (OB) (link to XOS=2095)
Preterm Birth Study orders
38. Diagnosis: preterm birth study # 1674



Nursing: assure that consent for preterm birth study # 1674 is signed & on chart.
Nursing: draw two 4.5 ml purple EDTA tubes of maternal venous blood upon admission for delivery.
Label w/ name, date and Preterm birth study 1674. Place in l&D utility room refrigerator for researcher.
Nursing: draw one 4.5 ml purple top(EDTA) tube of venous or arterial CORD blood after delivery from
funnel or bag. Label w/ name, date, CORD BLOOD and Preterm birth study 1674. Place in l&D utility
room refrigerator for researcher.
Physician Signature:
Date: ____________ Time: ______________
4 of 4
Initials: _________
Date:______/_____/_____
Time: ____:______