Severe HTN
PPH
RTS
Newborn
Miscellaneous
100

It is NOT indicated as an antihypertensive measure but used to prevent seizures in women with severe features of preeclampsia.

Magnesium Sulfate

100

1000 mls or greater in blood loss.

Hemorrhage 

100

A loss of 20 weeks or greater.

Stillborn

100

Caused by the fetal autonomic nervous system and circulating catecholamines in the presence of an elevated maternal temperature.

Etiology of fetal tachycardia

100

Complications that lead to macrosomia and increased risk of fetal demise.

Gestational Diabetes 

200

Absent proteinuria, new onset hypertension, and new onset headache, unresponsive to medication

Preeclampsia 

200

Completed on admission, 1 hour prior to delivery, within 1 hour after birth.

PPH risk assessment 

200

A requirement of seeing and holding baby, autopsy, checklist, memory box, and photos.

Stillbirth Legislation/Autumn Joy Act

200

Adjust mask, reposition airway, suction nose and mouth, open mouth, increase pressure, consider alternate airway.

MR SOPA

200

Placenta covers the opening of the cervix and can cause painless bright red bleeding during pregnancy.

Placenta Previa

300

Results from increased platelet activation, aggregation, and consumption.

Thrombocytopenia

300

First vital sign indicator is Tachycardia/tachypnea.

Hypovolemia 

300

An item taken into the room of all loss parents that contains items to help parents and family members through their grief.

Bereavement Cart

300

Swelling of newborn scalp, crosses suture lines.

Caput Succedaneum

300

Occurs when 2 separate oocytes are fertilized at the same time.

Di-zygotic twin

400

The first line agent and dosing to be used in treating severe hypertension.

Labetalol 20 mg 

400

Pitocin, methergine, hemabate, Cytotec, and TXA

Medications to treat PPH

400

A loss less than 20 weeks.

Miscarriage

400

HR less than 100, apnea, gasping.

Indicators for PPV

400

Loss of DTR’s, respiratory depression, diaphoresis, bradycardia.

Mag toxicity 

500

Includes genetic disposition, inflammatory responses, immunologic factors, preexisting maternal cardiovascular disease or metabolic syndrome.

Etiologies of Preeclampsia 

500

Uterine atony, retained placenta, defects in coagulation, uterine inversion, hematomas.

Etiologies of a primary hemorrhage 

500

This form needs to be completed by MD on all losses over 20 weeks and those less than 20 weeks if parents want to bury or cremate the baby.

VeriNJ Fetal Death Form

500

The single most important and effective step in neonatal resuscitation.  

Ventilation

500

Clotting components are exhausted and bleeding complications continue.

DIC (disseminated intravascular coagulation)