Full Clinical Guidelines - Community First Health Plans.

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EXAMINATION / TESTS 4. Follow-up Lab Triple screen Glucose Challenge test/H & H/Ab screen H & H/VDRL/Group B Strep 5. Postpartum Care Interim history and physical exam Evaluation of weight Vital signs Cervical cytology (as needed) Family planning / contraceptive practices STD prevention Assessment for postpartum depression At 8-20 weeks gestation At 24-28 weeks gestation At 35-37 weeks gestation 4-6 weeks after delivery SCHEDULE *optional Management of pregnancy requires establishing an estimated date of delivery. Problems such as intrauterine growth restriction, preterm labor, and postterm pregnancy are managed most effectively when an accurate estimated date of delivery is known. In addition, accurate gestational dating is important for the application and interpretation of certain antepartum tests (ie, maternal serum alpha-fetoprotein or assessment of fetal maturity). If there is a size-date discrepancy or if menstrual dates are uncer¬tain, an ultrasound examination is indicated for the purpose of dating. Such an examination is most accurate when performed before 20 weeks of gestation. Ultrasound results are considered to be consistent with menstrual dates if there is gestational age agreement to within 3 days by crown-rump length (CRL) measurement obtained at 6-10 weeks of gestation, within 5 days by CRL measurement obtained at 10-14 weeks of gestation, or within 7 days by the average of multiple measurements obtained at 14-20 weeks of gestation. Identification of risk factors is critical in order to minimize maternal and neonatal morbidity and mortality. In some instances, obstetric problems require a multidis¬ciplinary approach to antepartum care. Some conditions may require the involvement of a maternal-fetal medicine (MFM) subspecialist, geneticist, pediatrician, neonatologist, anesthesiologist, or other medical special¬ist in the evaluation, counseling, and care of the patient. Community First Health Plans actively outreaches to all identified program members to assess risk status and to assist both member and provider with managing risk factors once identified. Much of our program is based on member education surrounding how to identify risk factors associated with pregnancy. If you have a member who would benefit from this program, please make a referral by contacting CFHP. Approximately 4 – 6 weeks after delivery, the mother should visit her physician for a postpartum review and examination. The follow-up appointment interval may be modified according to the needs of the patient. A visit within 7-14 days of delivery may be advisable after a cesarean delivery or a complicated gestation. 144 H EALTH PLANS www.cfhp.com
The following variables should be examined when cesarean deliveries are performed: • When cervical dilation was less than 4 cm • In the presence of intact membranes • Without appropriate use of oxytocin • After the patient has received an epidural when cervical dilation was less than 4 cm • After the patient has undergone elective induction of labor at less than 41 completed weeks of gestation • Without trial of labor for suspected macrosomia in nondiabetic women • For failed induction of labor for suspected macrosomia in nondiabetic women • For the sole indication of twin gestation • For the indication of termed fetuses with breech presentations, without offering eternal cephalic version Taken from the Evaluation of Cesarean Delivery, American College of Obstetricians and Gynecologists, pages 34-35, 2000 ELECTIVE REPEAT CESAREAN SECTION GUIDELINES Before elective repeat cesarean delivery, the maturity of the fetus should be established. For patients with an indication for an elective repeat cesarean delivery, fetal maturity may be assumed if one of the following criteria is met: • Fetal heart tones have been documented for 20 weeks by nonelectronic fetoscope or for 30 weeks by Doppler ultrasound. • Thirty-six weeks have elapsed since positive results were obtained from a serum or urine human chorionic gonadotropin pregnancy test performed by a reliable laboratory. • Ultrasound measurement of the crown-rump length obtained at 6-11 weeks of gestation supports a current gestational age of 39 weeks or more. • Clinical history and physical and ultrasound examinations performed at 12-20 weeks of gestation support a current gestational age of 39 weeks or more. These criteria are not intended to preclude the use of menstrual dating. If any one criterion confirms gestational age assessment in a patient who has normal menstrual cycles and no immediate antecedent use of oral contraceptives, it is appropriate to schedule delivery at 39 weeks of gestation or later on the basis of menstrual dates. Taken from guidelines for Perinatal Care, Sixth Edition, American Academy of Pediatrics and American College of Obstetricians and Gynecologists, page 160 October 2007 17.2 Cesarian Section Guidelines VAGINAL BIRTH AFTER CESAREAN DELIVERY GUIDELINES Despite extensive data regarding the risks and success rates of vaginal birth after cesarean delivery (VBAC), there is relatively little information regarding how labor should be conducted: • External cephalic version for breech presentation may be as successful for VBAC candidates as for women who have not undergone previous cesarean delivery. • The use of prostaglandins for cervical ripening or labor induction in VBAC candidates is discouraged. If induction of labor is necessary for a clear and compelling clinical induction, the potential increased risk of uterine rupture with the use of prostaglandins should be discussed with the patient and documented in the medical record. • Oxytocin may be used for both labor induction and augmentation with close patient monitoring in VBAC candidates. • Once labor has begun, the patient should be evaluated promptly. Most authorities recommend continuos electronic monitoring of both fetal heart rate and uterine contractions. The most common sign of uterine rupture is a nonreassuring fetal heart rate pattern with variable decelerations that may evolve into late decelerations, bradycardia, and undetectable fetal heart rate. Personnel familiar with the potential complications of VBAC should be vigilant for nonreassuring fetal heart rate patterns and inadequate progress in labor. Because uterine rupture may be catastrophic and evolve rapidly, VBAC should be attempted in institutions equipped to respond to emergencies with physicians immediately available to provide emergency care. • Epidural analgesia and anesthesia may safely be used during a trial of labor and planned VBAC. Assurance of adequate pain relief during labor may encourage more women to choose a trial of labor. Success rates for VBAC are similar in women who do and those who do not receive epidural analgesia, as well as in those women who receive other types of pain relief. Epidural analgesia rarely masks the signs or symptoms of uterine rupture. The anesthesia service should be notified whenever there is a patient attempting VBAC in active labor on the labor floor. Taken from guidelines for Perinatal Care, Sixth Edition, American Academy of Pediatrics and American College of Obstetricians and Gynecologists, pages 156-157, October 2007 H EALTH PLANS www.cfhp.com 145
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Community First Health Plans Qualit
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10.5 ATP III Classification of Chol
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Such information is released only t
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Non Voting • Martin Jimenez, Dire
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The purpose of these guidelines is
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Table 1. Adult Preventive Services
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Recommended Adult Immunization Sche
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Footnotes — Recommended Adult Imm
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CFHP has adopted the National Asthm
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Patient Name ______________________
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Managing Asthma Long Term 41 FIGURE
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FIGURE 14. CLASSIFYING ASTHMA SEVER
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FIGURE 16. STEPWISE APPROACH FOR MA
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FIGURE 20. CLASSIFYING SEVERITY OF
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II. Some hyperactive-impulsive or i
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COMMUNITY FIRST HEALTH PLANS BEHAVI
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Criteria Requirements 33. Release o
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The evaluation of breast disease is
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Prevent Child Texas, a non-profit o
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AMERICAN ACADEMY OF PEDIATRICS: Fai
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possible), a careful, complete, and
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Examination/Test Oral / Dental Insp
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GLYCEMIC CONTROL BIBLIOGRAPHY • R
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Publication # 45-11647 Targets* A1
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WORKSHEET Revised 10-20-05 Advancin
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D. Optimizing analog insulin use Re
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Publication # 45-11266 Age 126 mg/d
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Hypertension Algorithm for Diabetes
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Lipid Algorithm For Type 1 and Type
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References: Revised 1-24-08 • Col
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WEIGHT LOSS ALGORITHM FOR OVERWEIGH
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Publication #45-11825 Screening 1 :
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Publication #45-12000 DIABETIC FOOT
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DIABETIC FOOT CARE/REFERRAL ALGORIT
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Publication # 45-12083 WEIGHT MANAG
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Revised 10-25-07 IV INSULIN INFUSIO
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Revised 10-25-07 Publication #: 45-
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Revised 2-21-08 Publication #: E45-
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Abbreviations AGI Alpha-Glucosidase
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Orders for Adults with DKA and Hype
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D i a b e t e s t r e a t m e n t a
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CFHP has adopted the National Insti
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No CHD; 0 to 1, or 2+ Risk Factors
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NATIONAL CHOLESTEROL EDUCATION PROG
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NATIONAL CHOLESTEROL EDUCATION PROG
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