4N Labor and Delivery
Standard Orders for Term Labor / Delivery
(Provider must sign all orders-check , circle each order desired and/or
fill in appropriate blanks)
Addressograph or place patient label
Admit
1.
2.
3.
4.
5.
6.
7.
Admit to:
L&D
4E
4S
4SMC
Attending: _______________, Beeper__________
Resident:_________________, Beeper__________
Team: _____________________
Enter Gestational Age: ______________
Diagnosis:
Term Labor
Term Induction @ _____ weeks
Allergy (drug, food, other) ____________________________________________
Treatments and Care Reminders
8. Weight: ____________
9. Notify House Officer: T>: 100 T<: 95 SBP>: 140 SBP<: 90 DBP>: 95 DBP<: 50 HR>: 120 HR<: 50 RESP>: 24
RESP<: 10 UOP<: 120ml/ 4h UOP with foley <60ml/ 2h; if O2 sats <92% apply O2 2L NC and NHO; altered
mental status; pain score >7 with current meds
10. Vital Signs per unit
11. Foley- Remove per D/C protocol – Remove at time of delivery
12. Clear liquid diet daily until discontinued – do not restrict glucose
13. In and out CATH PRN if unable to void spontaneously
14. Lidocaine 1% injection: 0.2 ml intrderm as dir (PRN anesthetic for IV start per patient preference)
15. Epifoam: 1 application topical prn (to beside for perineum pain)
16. Aromatic Ammonia spirit Inhalant: 1 ea inhalant prn (prn pre-syncope/syncope)
17. Trebutaline Inj: Brethine: 0.25 mg iv q2h prn (per protocol for EFM/TOCO indication.)
18. Nursing: Send fetal CORD blood gases (NOT maternal ABG): if fetal compromise, 5 minute apgar < 7,
severe IUGR, maternal thyroid disease, abnormal fetal heart tracing, intrapartum fever, and/or
multifetal gestations
19. Fetal Cord Blood Gas Arterial X 1 (If indicated by L&D protocol)
20. Fetal Cord Blood Gas Venous X 1 x1 (If indicated by L&D protocol)
Cord STAT collection will hold cord segment in lab in the event drug screen indicated per Peds provider.
21. Cord STAT Collection x1 (collection for peds provider)
22. Anesthesia Consult analgesia/anesthesia for labor & delivery
23. Fetal heart rate continuous external fhr monitoring and toco
24. Fetal Heart Rate Q30 Min: (1) document before, during and after one contraction every 30 minutes
during the active phase of the first stage of labor
25. Fetal Heart Rate Q15 Min: (2) document after a contraction during the second stage of labor
MC 7277 (04/2012)
4N Labor and Delivery
Standard Orders for Term Labor / Delivery
(Physician must sign all orders-check and/or fill in appropriate blanks)
Page 2 of 5
Activity
26.
ambulate with fetal reassurance
bedrest with bathroom privileges
bedrest
Labs: if no prenatal labs order HIV testing, Hepatitis, RPR, T&S
Obtain rapid HIV if anticipating delivery soon and 3rd trimester HIV testing unknown:
27. Rapid HIV L&D x1 pregnancy, hiv status unknown
28. Nursing: Give Source Patient "Rapid HIV-1 Antibody Test Information Booklet" (print from e-docs)
If results are NOT needed immediately:
29. HIV 1&2 AB & P24 AG BY CIA x1 /
30. Hepatitis B Surf Antigen X 1
31. RPR Qualitative blood X 1
32. Type & Screen (ABO/RH/ATBY SCN) X 1
33. Blood Band Misc Sample x1 (draw one purple top, send to blood bank to hold for workup)
IV Fluids
34. LR: Lactated Ringers 125 ml/hr iv
35. Nursing: No IV or heparin flush/ lock
36. Heparin 100UNITS/ML FLUSH SOLN 3 ml flush q12h (flush each shift)
37. Heparin 100UNITS/ML FLUSH SOLN 3 ml flush prn (flush prn after each access)
For Diabetic Patients
38. D5 1/2 NS: 125 ml/hr iv (via infusion pump)
39. NS: Sodium Chloride 0.9% 125 ml/hr iv
40. Blood Glucose Testing, OB Q2H
41. Blood Glucose Testing, OB Q1H if glucose is greater than 110 mg/dl or on insulin infusion
42. Regular Human Insulin INF: 1 units/hr iv now (notify Pharmacy when bag needed begin infusion for
blood glucose greater than 110 mg/dl on 2 consecutive measurements)
Analgesics & Antiemetics
43. Butorphanol: STADOL 1mg iv q6h prn (May repeat once in one hour if pain score remains greater than 4)
44. Nalbuphine Injection: NUBAIN 10 mg iv q8h prn (May repeat once within one hour if pain score remains
greater than 4)
45. Ondansetron Injection: 4 mg iv q6h prn (for nausea/vomiting)
MC 7277 (04/2012)
4N Labor and Delivery
Standard Orders for Term Labor / Delivery
(Physician must sign all orders-check and/or fill in appropriate blanks)
Page 3 of 5
GBS Prophylaxis
For Unknown GBS status order antibiotics if: EGA<37 wks, membranes ruptured>18hrs, temp>100.4, GBS
UTI w/current pregnancy, hx of infant with GBS sepsis
46. Penicillin-G injection 5 million units IV now X 1, as loading dose for patient 5 mu IV X 1 now (loading
dose)
Penicillin-G injection: 2.5 mu IV q4h =+4hr (discontinue post –delivery)
If penicillin allergic and low risk of anaphylaxis:
47. Cefazolin Inj: ANCEF 2000 mg iv x1 now (loading dose)
 Cefazolin Inj: ANCEF 1000 mg iv q8h =+8h (discontinue post delivery)
If penicillin allergic and high or unknown risk of anaphylaxis
GBS isolate testing available and sensitive to clindamycin and erythromycin:
48. Clindamycin Inj: CLEOCIN 900 mg iv q8h now (discontinue post delivery)
OR … GBS isolate sensitivity unavailable/unknown OR GBS resistant to clindamycin OR patient allergic to all
beta lactams and clindamycin
49. Vancomycin Injection: 1000 mg iv q12hx2 doses now (NHO if patient still laboring at last dose)
Epidural Analgesia
50. NURSING: Epidural_1: Order the epidural tray, pump and tubing
 Epidural_2: Baseline heart rate, blood pressure and SpO2 prior to epidural placement
 Epidural_3: Nurse: remain with patient during epidural placement to assist with positioning and
monitoring
 Epidural_4: Prepare 1 liter IV fluid (LR or NS) for administration in the case of an emergency
 LR BOLUS 1000 ml iv prn (in case of emergency during epidural analgesia)
 NS BOLUS 1000 ml iv prn (in case of emergency during epidural analgesia)
 epidural_5: insert a 3-way stopcock in IV tubing to permit administration of meds or fluids, if needed in
an emergency
 epidural_6: monitor spo2 continuously during epidural placement; maintain sat monitor availability, but
discontinue monitoring after placement
 epidural_7: vital signs q2 minutes immediately after epidural placement; when directed by anesthesia,
q15 minutes x1hour; then, if stable, q30 minutes
 epidural_8: Remove BP cuff between measurements, maintain its availability
 epidural_9: bolus up to 500 ml of current infusing IV fluid prior to epidural placement
MC 7277 (04/2012)
4N Labor and Delivery
Standard Orders for Term Labor / Delivery
Page 4 of 5
(Physician must sign all orders-check and/or fill in appropriate
blanks)
Choose level of fetal monitoring:
 epidural_10: Continuous fetal monitoring x1 hour after epidural placed; then, if stable, may monitor
intermittently
 epidural_11: continuous fetal monitoring
If patient chooses nitrous analgesia:
51. Nursing: Notify Anesthesia to initiate Nitrous oxide protocol (policy: Nitrous Oxide use in the
Intrapartum/Immediate Postpartum Period
Cervical Ripening
52. Misoprostol: CYTOTEC 25 mcg vaginal q4hx2 doses now
53. Misoprostol: CYTOTEC 25 mcg po q4hx2 doses now
Induction/Augmentation-choose one dosing regimen:
54. oxytocin 15 units in ns 250 ml : pitocin 1 bag iv as dir now (start at 1 milliunit per minute and increase by 1
milliunit q 30 minutes)
55. oxytocin 15 units in ns 250 ml : pitocin 1 bag iv as dir now (start at 2 milliunit per minute and increase by 2
milliunit q 30 minutes)
Third Stage of Labor: Choose Pitocin Order:
56. 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).)
 NURSING: process cord blood for T&S, send directly to blood bank.
57. oxytocin 15 units in ns 250 ml : pitocin 2 bag iv as dir (rate 125ml/hr x 4 hours; start after delivery of
***placenta.)
 NURSING: process cord blood for T&S, send directly to blood bank.
Select one if oxytocin is NOT ordered upon transfer to floor:
58. Post-Procedure Nursing Order: No oxytocin is ordered for this patient: Patient is low risk and no oxytocin is
indicated.
59. Post-Procedure Nursing Order: No oxytocin is ordered for this patient upon transfer to floor: Patient
declines oxytocin.
60. Post-Procedure Nursing Order: No oxytocin is ordered for this patient upon transfer to floor: other___.
For repair of lacertations:
61. Lidocaine 1% Injection: 20 ml infiltra x1 (for repair of lacerations by provider)
Physician Signature:
Date: ____________ Time: ______________
MC 7277 (04/2012)
Page 5 of 5
MC 7277 (04/2012)