Name:
Alice Peck Day Memorial Hospital
Second Stage Flowsheet – Birthing Center
MR#:
DOB:
ALLERGIES:
GRAVIDA
PARA
DIL – Dilatation
Station with UC-station with
contraction
Station without UC-station
between contractions
SROM
NKDA
place patient sticker here
AROM
Date:
EDC
Fluid
Time:
Blood Type
Date/Tim of:
Estimated fetal weightComplete dilation-_______
Pushing-____________
__________________
Vital Signs
Date
T
Time
Document1
P
R
BP
Cervical Exam
O2
Sat
(#011691)
DTR
Dil
Eff
Clonis
(5/13)
Statio
n with
UC
Station
w/o UC
Mode
Category
D – Doppler
US – Ultrasound
FSE – Fetal Scalp
Electrode
N – None
A – Acceleration
LD – Late Decel
ED – Early Decel
VD – Variable
PD - Prolonged
I
II
III
I – Intact
C – Clear
M – Meconium stained
TM – Thick meconium
B – Bloody
Uterine Activity
Mode
Freq
Dur
Qual/
hgmm
Page 1 of 2
Periodic Changes
Treatment
Comfort Measures
F – Fluid Bolus
02 – Oxygen
Pos ∆
LS – Left Side
RS – Right Side
HK – Hands and Knees
Tren – Trendelemburg
B – Ball
W – Walking
M – Massage
BR – Breathing
H20 – Water
WP – Warm Pack
MED – Medication
EPI – Epidural
IT - Intrathecal
Variability
A – Absent
Mi – Minimal
Mo – Moderate
Ma – Marked
Fetal Assessment
Mode
FHR
Baseline
Cat
Per∆’s
Var
Assessment
TX
Pushing
wellY/N
Assessment
Pushing well
Comments/Plan
Communication-
Y - Yes
N - No
PC – Phone Call
BS – CNM/OB at bedside
VC – Verbal Communication
H- Huddle
P-Patient/family
Time of next huddle30 minutes
60 minutes
Medication
Other
Mag
Pitocin
Sulfate
Mu/min
Intake/Output
PO
IV
Urine
Emesis
Comments/Plan
Communication
Init
RN
1
RN
2
Name:
Alice Peck Day Memorial Hospital
MR#:
Second Stage Flowsheet – Birthing Center
DOB:
ALLERGIES:
GRAVIDA
PARA
AROM
Fluid
Date:
I – Intact
C – Clear
M – Meconium stained
TM – Thick meconium
B – Bloody
EDC
Time:
Blood Type
Vital Signs
Date
T
Time
Document1
P
R
BP
Cervical Exam
O2
Sat
(#011691)
DTR
Dil
Eff
Mode
DIL – Dilitation
EFF – Effacement
STA – Station
SROM
NKDA
place patient sticker here
Sta
Fluid
Uterine Activity
Mode
Freq
Clonis
Dur
Qual/
hgmm
(5/13)
Page 2 of 2
Category
D – Doppler
US – Ultrasound
FSE – Fetal Scalp
Electrode
Periodic Changes
Treatment
N – None
A – Acceleration
LD – Late Decel
ED – Early Decel
VD – Variable
PD - Prolonged
I
II
III
F – Fluid Bolus
02 – Oxygen
Pos ∆
LS – Left Side
RS – Right Side
HK – Hands and Knees
Tren – Trendelemburg
Variability
A – Absent
Mi – Minimal
Mo – Moderate
Ma – Marked
Fetal Assessment
Mode
FHR
Baseline
Cat
Per∆’s
Var
Coping Assessment
TX
√
*
Comfort Measures
Resp
+/-
Comfort Measures
B – Ball
W – Walking
M – Massage
BR – Breathing
H20 – Water
WP – Warm Pack
MED – Medication
EPI – Epidural
IT - Intrathecal
Medication
Other
Mag
Pitocin
Sulfate
Mu/min
Coping Well Per
Patient
√ - Yes
* - No
Response
IV
PC – Phone Call
BS – CNM/OB at bedside
VC – Verbal Communication
+ - Relief
+/- - Some relief
-- No relief
Intake/Output
PO
Mode
Every 2 Hours
Urine
Emesis
Comments
Communication
Init