Guidelines for Perinatal Services, Eighth Edition, 2013 Appendix Table of Contents Contents Appendix 1. Vital Statistics Terms Defined ........................................................................................... 1 Appendix 2. Maternal—Fetal Transport ............................................................................................... 2 Appendix 3. Antenatal Administration of Steroids ............................................................................... 4 Appendix 4. Maternal—Fetal Vital Signs in Labor ................................................................................. 5 Appendix 5. Vaginal Birth after Cesarean and Trial of Labor after Cesarean ........................................ 9 Appendix 6. Oxytocin for Induction and Augmentation of Labor ....................................................... 11 Appendix 7. Neonatal Assessment ...................................................................................................... 14 Appendix 8. Statute and Rules for Ophthalmia Prophylactics ............................................................ 17 Appendix 9. Center for Congenital and Inherited Disorders .............................................................. 18 Appendix 10. Newborn Hearing Screening ........................................................................................... 19 Appendix 11. Neonatal Transport-Medical and Legal Concerns ........................................................... 24 Appendix 12. Discharge Planning and Health Education ...................................................................... 27 Appendix 13. Iowa High Risk Infant Follow-up Program ....................................................................... 32 Appendix 14. Outreach Education ........................................................................................................ 33 Appendix 15. Pregnancy and HIV (Human Immunodeficiency Virus) ................................................... 34 Appendix 16. Group B Streptococcal Disease ....................................................................................... 38 Appendix 17. Male Newborn Circumcision ........................................................................................... 44 Appendix 18. Managing Newborn Hyperbilirubinemia and Preventing Kernicterus ............................ 48 Appendix 19. Perinatal Illicit Substance Exposure in Infants and Pregnant Women ............................ 60 Appendix 20. Hepatitis B ....................................................................................................................... 67 Appendix 21. Induced Therapeutic Hypothermia for Newborns with Moderate to Severe Hypoxic Ischemic Encephalopathy ............................................................................................... 69 Appendix 22. Progesterone Therapy to Prevent Preterm Birth ............................................................ 73 Appendix 23. Preventing Shaken Baby Syndrome and Abusive Head Trauma ..................................... 75 Appendix 24. Sudden Unexpected Infant Death and Sudden Infant Death Syndrome ........................ 79 Appendix 25. Cocooning for Pertussis .................................................................................................. 87 Appendix 26. Breastfeeding Term & Late Preterm Infants ................................................................... 89 Appendix 27. Tobacco Cessation........................................................................................................... 99 Appendix 28. Influenza Immunization for Pregnant Women & Health Care Workers ....................... 102 Appendix 29. Eliminating Elective Delivery Prior to 39 Weeks Gestation .......................................... 104 Appendix 30. Intimate Partner Violence ............................................................................................. 107 Appendix 31. Guidelines for Newborn Screening for Critical Congenital Heart Disease .................... 112 Appendix 32. Management of Late-Preterm Infants .......................................................................... 120 Appendix 33. Management of Newborns with Suspected Early-Onset Sepsis ................................... 121 Appendix 34. Neonatal Abstinence Syndrome ................................................................................... 124 Acknowledgement The Perinatal Guidelines Advisory Committee would like to acknowledge the following individuals for their dedication and generous contribution of time and talents to the development of these appendices. Greg Garvin, DO Chairperson, Dennis Rosenblum, MD, Vice Chair, Debra Piehl MD, Susan Berends, RNC, MA, NNP, PNP, Deb Renner, RNC, BSN, Ashley Engelbrecht RN, BSN, JD, Jeffrey Segar MD, Stephen Hunter, MD PhD, John Dagle MD, PhD, Penny Smith RNC, BSN, Rachel Woodard RNC, BSN, Laura Malone RN, MSN, Debra Waldron MD, MPH, Jeannette Hasley RN, BSN, Laura Ferguson MD, Diane Petsche RN, BSN and Stephanie Trusty RNC, BSN Appendix 1 Appendix 1. Vital Statistics Terms Defined Fetal death: means death prior to the complete expulsion or extraction from its mother of a product of human conception, irrespective of the duration of pregnancy. Death is indicated by the fact that after expulsion or extraction the fetus does not breathe or show any other evidence of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles. In determining a fetal death, heartbeats shall be distinguished from transient cardiac contractions, and respirations shall be distinguished from fleeting respiratory efforts or gasps.1 (Commonly referred to as “stillbirth”) Infant death: death of a liveborn infant under one year of age; includes both neonatal and postneonatal deaths 3 Live birth: means the complete expulsion or extraction from its mother of a product of human conception, irrespective of the duration of pregnancy, which, after such expulsion or extraction, breathes or shows any other evidence of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached. In determining a live birth, heartbeats shall be distinguished from transient cardiac contractions, and respirations shall be distinguished from fleeting respiratory efforts or gasps.1 Maternal Death: A maternal death is any death occurring while a woman is pregnant or of a woman within one year after delivery. This includes but is not limited to deaths resulting from abortions, ectopic pregnancies and all deaths during pregnancy, childbirth, puerperium or deaths from complications of childbirth. In the event of a maternal death, the certifying physician shall indicate that circumstance on the certificate of death.2 Neonatal death: death of a liveborn infant occurring within the first 27 days of life3 Perinatal death: death of a fetus of greater than 20 weeks’ gestation or death of a liveborn infant under 28 days of life3 Postneonatal death: death of a liveborn infant after the first 27 days of life, but before one year of age3 1. Iowa Code 144.1/Title IV Public Health/Subtitle 2 Health-Related Activities Definitions 641.4—IAC/Genetics/Definitions 2.641—5.1(135) Iowa Administrative Code 3. 2005 Vital Statistics of Iowa, Iowa Department of Public Health, Center for Health Statistics. Available at: http://www.idph.state.ia.us/apl/common/pdf/health_statistics/2005/vital_stats_2005. Accessed June 4, 2013. Guidelines for Perinatal Services, Eighth Edition, Appendices Updated August 2013 1 Appendix 2 Appendix 2. Maternal—Fetal Transport Maternal-fetal transport is an essential component of modern perinatal care. All facilities in the state providing obstetrics need to be familiar with their own resources and capabilities in dealing with obstetrical and neonatal complications. In most instances, maternal-fetal transport is preferable to neonatal transport. Each hospital, when transporting or accepting a transport, needs a system in place to facilitate a smooth transition of care in the most expeditious manner possible. The majority of maternal-fetal transports can be carried out by ground transportation. It is important for ambulance services to be equipped for maternal-fetal transport and have appropriately trained staff. Maternal-fetal transports must be conducted and accomplished in compliance with EMTALA rules and regulations; see the EMTALA reference on page 3 of these guidelines. Particular attention must be given to areas regarding appropriate medical screening as it relates to women in labor and transfer requirements. EMTALA rules do not preclude appropriate transfer of women in labor with careful documentation of the need for transport. The transferring hospital and physician must ensure that the skills and equipment available during transport will meet the anticipated needs of the maternal-fetal dyad rather than assume that everyone onboard an ambulance or aircraft is adequately trained. Specific attention should be placed on neonatal resuscitation skills. If the referring hospital chooses to set up its own transport for the purpose of “saving time” and getting the patient to the receiving hospital sooner, it must understand that it is fully responsible for the patient until arrival at the receiving institution. It is important that when a referring hospital refuses a transport team after it has been recommended, the receiving hospital document