SOC for patients under 34 weeks...

[MickeymomRN]

I need help finding out the standards of care for patients under 34 weeks who need a vag check or spec exam for ferning or cervical checks.

I am looking for information regarding the care of these patients.

Do you as the nurse perform these checks/procedures?

Please, tell me what type of facility you work at. ie. tertiary, NICU level, etc.

Also, include if you have an OB, attending or resident, as well as anesthesia in house 24/7.

Greatly appreciate your help!!

PS- if you have a policy regarding this issue, can you email or fax me a copy??? no one will be held liable for any info I am gathering for a research project.

[jenny456]

HI,

I'll try to answer some of your questions. I am currently not working while I recover from illness, but I was an L&D nurse at a high volume, high risk L & D. We delivered about 5000 babies a year and rarely accepted anyone less than 20 weeks. lady partsl checks were done by the nurses. For someone 34 weeks or ealier, lady partsl checks were done on admission by the nurse (only if the patient is really contracting away or complaining of abdominal pain.) If the patient is there for some other reason--such as high BP or illness, usually a sonogram was done which will reveal any possible dilation and cervical thinning. Doctors would sometimes do a speculum exam to peek in there, but most often, we nurses had to do a gentle vag exam (only if it was warrented). Overall, lady partsl exams were kept to a minimum anyway and is some special cases (buldging membranes), speculum exams replaced lady partsl exams. Just as I left the facility, we were being trained to do speculum exams ourselves and to collect fluids around the cervix for testing. We nurses already frequently did nitrazine tests for rupture of memebranes, but the doctors were responsible for interpreting the fern test.

We always had anesthesia 24/7 and could also call a second anesthesiologist in if necessary from another part of the hospital. Personally, I would never work anywhere where there is not 24/7 anesthesia--too dangerous. Also, there is always an OB 24/7 called a "OB hospitalist" who covered other doctors until they arrived. Doctors from the various practices that delivered at our hospital took turns being the hospitalist. Hope this helps some. Maybe contact AWHONN and see what they have to say about this.

[bagladyrn, RN]

I've worked at all sizes and types of facilities as both staff and traveler. I will generally only do an SVE on those under 34 weeks before calling the MD if they seem to be in danger of an imminent delivery. Otherwise I will monitor, assess and call the MD. Since I work nights, the MD will usually then give me an order for a "gentle" SVE (like I'd ever do a "rough" one!).

Depending upon the policy of the facility I may or may not do a speculum exam.

[MickeymomRN]

Thanks for the answers!!!

I actually looked up the AWHONN policy template for triaging the OB patient.....

they recommend that patients under 34 weeks be evaluated by a physician.....

woohoo.....I have been trained correctly.....now I have to get this place to comply with standards....