Want some info @ high risk antepartum units

[altomga, ADN, BSN, MSN, DNP, RN, APRN]

I am hoping to get some information on what other hospitals are doing on their antepartum units. What types of patients do you take, (PIH, PPROM, GDM...etc?) continuous fetal monitoring done?, what is the ratio?, how often do you jump patients back and forth between L/D and the antepartum floor. Is the high risk unit a unit by itself or entwined with postpartum?

I work in a facility that the antepartum is with the postpartum and LD typically hold a lot of antepartum patients for various reasons..mostly because the floor doesn't take high risk patients... Oh..we do have a 50 BED NICU that takes any and all preterm babies.

So I am trying to get as much info as possible to get a proposal together.

Thanks for any help ya'll can provide!!!

[agiboma, BSN, MSN, NP]

I am not sure if every hospital is different, but when my pregnancy went high risk i was transferred to a level 3 hospital and their high risk antipartum and regular antipartum where two seperate units. Its expected that the high risk will have all the conditions you mentioned in your original post and much more, on the floor where i spent the last month of my pregnancy i saw a lot of women with IC, TTC, PPROM, PIH, HELLP syndrom, eclamsia etc. On that high risk unit women with PIH, HELLP etc had a private room because of the constant BP monitoring. If your knew to the high risk side GL

[Elvish, BSN, DNP, RN, NP]

On my unit high-risk antepartum is mixed in with mother/baby, although we are about to change to a new unit. That unit will, I believe, have a separate sub-wing for antepartums, but staffed by the same people.

Most of our high-risk antes are PPROM, PTL, abruptions, previas after their sentinel bleed. Occasionally we'll have someone with high-order multiples (triplets/quads) on bedrest after a certain gestation.

AWHONN recommends 1:3 or 4 if they are stable. How often they are monitored depends on gestation and/or whether they are ruptured. Our abruptions/previas get monitored q day if their membranes are intact. If any pt is >24 weeks and ruptured, the NSTs are BID. Always we get FHTs q shift on everyone in addition. If they are in for something not directly r/t the pregnancy - say, pyelonephritis - they might just get heart tones qshift.

[Calabria, BSN, RN]

Our floor is a mixed high-risk antepartum floor with postpartums. We get antepartum moms with hyperemesis, PPROM, PTL, GDM, pyelo, previa/abruption, sickle cell crisis, PIH/pre-eclampsia, cervical incompetency. We also get high-risk moms with congenital cardiac issues, we've had a few moms s/p MI who were pregnant, and some post-op moms who had random surgeries. Because of our staffing ratios, we don't do continuous monitoring... our orders for monitoring depend on the GA of the fetus (doptones qshift, or intermittent monitoring more frequently).

[RNLaborNurse4U]

We have separate units --

L&D: triage, labor, birth, high risk antepartum patients that are unstable or require continuous fetal monitoring. Also high risk postpartum patients on magnesium or s/p postpartum hemorrhage. Nurse/patient ratio is 1 nurse/1-3 patients (depending on acuity).

Antepartum: stable antepartums that do NOT need continuous EFM. This can be pre-term labor (stable), pre-eclampsia (stable), or miscellaneous antepartum stable patients. The key word is STABLE. The nurse/patient ratio is 1 nurse/6 patients.

Postpartum: only stable postpartum patients. Ratio is 1 nurse/4 couplets.