Time-efficient, cost-effective perinatal education and training PCEP Perinatal Continuing Education Program, 3rd Edition, Book I Continuing 3rd Edition, Education Perinatal Program, PCEP PCEP Perinatal Continuing Education Program BOOK Perinatal Continuing Education Program, 3rd Edition I 3RD EDITION EDITOR IN CHIEF, NEONATOLOGY Robert A. Sinkin, MD, MPH, FAAP PCEP Workbook Contents EDITOR IN CHIEF, OBSTETRICS EARN UP TO Christian A. Chisholm, MD, FACOG 54 CME MATERNAL AND FETAL EVALUATION AND IMMEDIATE CREDITS OR NEWBORN CARE (BOOK I) • Is the Mother Sick? Is the Fetus Sick? For more than 35 years, the Perinatal CONTACT HOURS! • Fetal Age, Growth, and Maturity Continuing Education Program (PCEP) • Fetal Well-being Maternal and Fetal has enhanced the knowledge and skills of • Is the Baby Sick? physicians, nurses, nurse midwives and • Resuscitating the Newborn practitioners, respiratory therapists, and other • Gestational Age and Size and Associated Risk Factors providers of care for pregnant women and newborns. • Thermal Environment • Hypoglycemia Evaluation and Immediate The third edition PCEP workbooks have been brought up-to-date with leading-edge procedures and techniques. These information-rich MATERNAL AND FETAL CARE (BOOK II) • Hypertensive Disorders of Pregnancy volumes are filled with concise information, step-by-step instructions, • Obstetric Hemorrhage and practice-focused exercises. They offer time-saving, low-cost • Perinatal Infections solutions for self-paced learning or as adjuncts to instructor-led Newborn Care • Other High-risk Conditions skills teaching. • Abnormal Glucose Tolerance PCEP IS A PROVEN EDUCATIONAL TOOL FOR • Premature Rupture or Infection of the Amniotic • Improving perinatal care know-how, policies, practices, and Membranes procedures. • Preterm Labor • Teaching both practical skills and cognitive knowledge. • Inducing and Augmenting Labor • Abnormal Labor Progress and Difficult Deliveries • Saving time—self-paced self-study approach streamlines the • Imminent Delivery and Preparation for Maternal/ learning process. Fetal Transport • Saving money—provide top-notch education at low per-participant costs. NEONATAL CARE (BOOK III) • Oxygen • Encouraging cooperation and communication among diverse • Respiratory Distress specialties and staffing levels. • Umbilical Catheters • Simplifying education planning and budgeting. • Low Blood Pressure • Intravenous Therapy CONVENIENT, HASSLE-FREE CME OR CONTACT HOURS • Feeding • Hyperbilirubinemia AMA PRA Category 1 Credit(s)™ or ANCC contact hours • Infections are available from the University of Virginia. Visit www.cmevillage.com for more information. • Review: Is the Baby Sick? Identifying and Caring for Sick and At-Risk Babies The University of Virginia School of Medicine is accredited by • Preparation for Neonatal Transport the Accreditation Council for Continuing Medical Education Earn to provide continuing medical education for physicians. SPECIALIZED NEWBORN CARE (BOOK IV) CME credits The University of Virginia School of Nursing is accredited as • Direct Blood Pressure Measurement a provider of continuing nursing education by the American • Exchange, Reduction, and Direct Transfusions or contact Nurses Credentialing Center’s Commission on Accreditation. • Continuous Positive Airway Pressure • Assisted Ventilation With Mechanical Ventilators hours! • Surfactant Therapy THE PCEP WORKBOOKS AND RELATED PRODUCTS CAN BE PURCHASED DIRECTLY • Continuing Care for At-Risk Babies FROM THE AMERICAN ACADEMY OF PEDIATRICS AT SHOP.AAP.ORG. AAP PCEP Perinatal Continuing Education Program Maternal and Fetal Evaluation and Immediate Newborn Care BOOK I 00a_FM_BKI_PCEP_i-viii.indd 1 9/2/16 3:56 PM American Academy of Pediatrics Publishing Staff The original version of these self-instructional Mark Grimes, Director, Department of Publishing books was developed in 1978 at the Eileen Glasstetter, MS, Manager, Product Development University of Virginia under contract Theresa Wiener, Manager, Publishing and Production (#N09-HR-2926) from the National Heart, Services Lung, and Blood Institute. Subsequent Jason Crase, Manager, Editorial Services versions have been developed independently Amanda Helmholz, Editorial Specialist by the authors and, for the current edition, an Peg Mulcahy, Manager, Graphic Design and Production editorial board. Mary Lou White, Director, Department of Marketing and Original PCEP Authors Sales John Kattwinkel, MD, FAAP Linda Smessaert, MSIMC, Marketing Manager, Professional Lynn J. Cook, RNC, MPH Publications Hallam Hurt, MD, FAAP George A. Nowacek, PhD Published by the American Academy of Pediatrics Jerry G. Short, PhD 141 Northwest Point Blvd Elk Grove Village, IL 60007-1019 Original Primary Authors for the Obstetric Telephone: 847/434-4000 Content Facsimile: 847/434-8000 Warren Crosby, MD www.aap.org Lynn J. Cook, RNC, MPH Information about obtaining continuing medical education and continuing education credit for book study may be obtained by visiting www.cmevillage.com. Several different approaches to specific perinatal problems may be acceptable. The PCEP books have been written to present specific recommendations rather than to include all currently acceptable options. The recommendations in these books should not be considered the only accepted standard of care. We encourage development of local standards in consultation with your regional perinatal center staff. Statements and opinions expressed are those of the authors and not necessarily those of the American Academy of Pediatrics. Every effort has been made to ensure that the drug selection and dosage set forth in this text are in accordance with the current recommendations and practice at time of publication. It is the responsibility of the health care professional to check the package insert of each drug for any change in indications and dosage and for added warnings and precautions. Products and Web sites are mentioned for informational purposes only and do not imply an endorsement by the American Academy of Pediatrics. Web site addresses are as current as possible but may change at any time. Brand names are furnished for identification purposes only. No endorsement of the manufacturers or products mentioned is implied. No commercial involvement of any kind has been solicited or accepted in development of the content of this publication. The publishers have made every effort to trace the copyright holders for borrowed materials. If they have inadvertently overlooked any, they will be pleased to make the necessary arrangements at the first opportunity. Special discounts are available for bulk purchases of this publication. E-mail our Special Sales Department at [email protected] for more information. © 2017 University of Virginia Patent Foundation All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means—electronic, mechanical, photocopying, recording, or otherwise—without prior permission from the publisher (locate title at http://ebooks.aappublications.org and click on © Get Permissions; you may also fax the permissions editor at 847/434-8780 or e-mail [email protected]). First American Academy of Pediatrics edition published 2007; second, 2012. Original edition © 1978 University of Virginia. Printed in the United States of America 5-280/1016 1 2 3 4 5 6 7 8 9 10 PC0019 ISBN: 978-1-61002-052-7 eBook: 978-1-61002-053-4 Library of Congress Control Number: 2016932958 00a_FM_BKI_PCEP_i-viii.indd 2 9/2/16 3:56 PM Perinatal Continuing Education Program (PCEP), 3rd Edition Textbook Editorial Board Editors Editor in Chief, Neonatology Editor in Chief, Obstetrics Robert A. Sinkin, MD, MPH, FAAP Christian A. Chisholm, MD, FACOG Charles Fuller Professor of Neonatology Associate Professor of Obstetrics and Gynecology Division Head, Neonatology Vice Chair for Education Medical Director for Newborn Services Medical Director, Labor and Delivery Department of Pediatrics University of Virginia Medical Center University of Virginia Children’s Hospital Charlottesville, VA Charlottesville, VA PCEP Editorial Board Members Lorie Banker, BSN, RNC Barbara O’Brien, RN, MS Care Coordinator Program Director Golisano Children’s Hospital Office of Perinatal Quality Improvement Rochester, NY The University of Oklahoma Health Sciences Center Melissa F. Carmen, MD, FAAP Oklahoma City, OK Assistant Professor of Pediatrics Division of Neonatology Chad Michael Smith, MD University of Rochester Medical Center Associate Professor of Obstetrics & Gynecology Rochester, NY Medical Director, Labor & Delivery Medical Director, Perinatal Patient Safety Susan B. Clarke, MS, RNC-NIC, RN-BC, CNS University of Oklahoma Health Sciences Center Professional Development Specialist Medical Director, Oklahoma Perinatal Quality Continuing Education and Outreach Improvement Collaborative Primary Nurse Planner Oklahoma City, OK Children’s Hospital Colorado Aurora, CO Jonathan R. Swanson, MD, MSc, FAAP Associate Professor of Pediatrics Ann Kellams, MD, FAAP, IBCLC, FABM Division of Neonatology Associate Professor, Department of Pediatrics Chief Quality Officer for Children’s Services Director, Well Newborn and Breastfeeding Medical Director, Neonatal Intensive Care Unit Medicine Services University of Virginia Children’s Hospital University of Virginia Children’s Hospital Charlottesville, VA Charlottesville, VA Sharon Veith, MSN, RN Sally Ann Miller, CNM, NP Assistant Professor Advanced Practice Registered Nurse University of Virginia School of Nursing