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SPONTANEOUS ABORTION (<20 weeks)
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INTRAUTERINE FETAL DEMISE (>20 weeks)
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INDUCED ABORTION
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NEONATAL DEATH (ANY GESTATIONAL AGE)
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DEFINITIONS
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Absence of fetal cardiac activity
OR
- GA unknown and POC <350 grams without placenta
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Absence of fetal cardiac activity
OR
- GA unknown and POC >350 grams without placenta
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Purposeful termination of pregnancy with intention other than producing a live-born infant or removing a dead fetus
- Maternal or fetal indication
- Undesired pregnancy <24 weeks gestation
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Product of human conception which, irrespective of the duration of pregnancy, shows any evidence of life (breathing, beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles) which then ceases to be present after any duration of time
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MANAGEMENT
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- Clinician assigns APGARs
- Nursing assigns MRN
- Clinician pronounces time of death
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INDUCTION OF LABOR/ DELIVERY PLANNING
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Offer:
Contact Complex Family Planning (CFP) Fellow if patient to be admitted to L&D for IOL.
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Offer:
- See and hold, time with family
- Hand/footprints, photographs and/or molds (L&D staff)
- Memory box if desired and feasible
- Support services
- Grief packet
Discuss
- Pain management for IOL and/or for procedure
Contact Complex Family Planning (CFP) Fellow if patient to be admitted to L&D for IOL.
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Offer:
- See and hold, time with family
- Hand/footprints, photographs and/or molds (L&D staff)
- Memory box if desired and feasible
- Support services
- Grief packet
Discuss
- Pain management for IOL and/or for procedure
Contact Complex Family Planning (CFP) Fellow if patient to be admitted to L&D for IOL.
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Offer:
If anticipate prolonged signs of life:
- Comfort care (palliative care) consultation
- Neonatology consultation
- Neonatal admission and/or resuscitation plan
- Refer to Procedure for Fetal Palliative Registration
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OB TECH REGISTRATION DUTIES ON L&D
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- Do NOT add to delivery log
- No MRN given
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- Add to delivery log
- No MRN given
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- Do NOT add to delivery log
- No MRN given
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>350 grams
- Register to L&D
- Add to delivery log
- Assign an MRN
- Discharge at time of death
< 350 grams
- Register to L&D
- Assign MRN
- Discharge at time of death
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GENETIC TESTING OPTIONS
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If clinically relevant, consider for >13w:
Instructions for sending ANORA. MUST walk specimen to the lab
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If clinically relevant, consider:
Instructions for sending ANORA. MUST walk specimen to the lab
Instructions for sending placental cell culture
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If clinically relevant, consider:
Instructions for sending ANORA. MUST walk specimen to the lab
Instructions for sending placental cell culture
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If clinically relevant, consider:
Instructions for sending ANORA. MUST walk specimen to the lab
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EMBRYONIC/FETAL/
NEONATAL REMAINS
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<20w OR <350g intact with unknown GA, excluding placenta:
- Send POCs/fetus to SURGICAL PATHOLOGY
Fill out Fetal Remains Tracking + Removal Form to indicate family preference for funeral home, hospital (standard pathology disposal) or family disposition of remains
Complete Surgical pathology form and indicate preference for funeral home, hospital or family of remains
If patient elects for family disposition, provide patient with number for gross pathology room (505) 272-2445, weekdays 8a-5p) to arrange pickup
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>20w OR >350g intact with unknown GA, excluding placenta:
- Send to WSC MORGUE
- Send to OMI if autopsy desired
- Fetal dysmorphologist (if desired) examines fetus at WSC morgue prior to sending to OMI for autopsy
Fill out Fetal Remains Tracking + Removal Form to indicate family preference for funeral home, hospital (standard pathology disposal) or family disposition of remains
- Sign this form if opts for hospital disposition
- Charge nurse on WSC will assign tracking ID
If >36 weeks gestation or 6 pounds/2800 grams:
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<20w or <350g if GA unknown:
- Send POCs/fetus to SURGICAL PATHOLOGY
>20w or >350g if GA unknown:
- Send to WSC MORGUE
- Send to OMI if autopsy desired
- Fetal dysmorphologist (if desired) examines fetus at WSC morgue prior to sending to OMI for autopsy
Fill out Fetal Remains Tracking + Removal Form to indicate family preference for funeral home, hospital (standard pathology disposal) or family disposition of remains
- Sign this form if opts for hospital disposal.
- Charge nurse on WSC will assign tracking ID
If 6 pounds/2800 grams:
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ALL NEONATES:
- Send to WSC MORGUE
- Send to OMI if autopsy desired
- No signs of life: not a neonatal death; see IUFD
Fill out Fetal Remains Tracking + Removal Form AND indicate preference for funeral home or family disposition of remains
- Charge nurse on WSC will assign tracking ID
- Hospital disposition is not an option for neonatal deaths
If >36 weeks gestation or 6 pounds/2800 grams:
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EMR DOCUMENTATION
AND FORMS
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Note template for SAB
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If >20 weeks GA OR unknown G and >350g:
- NOT necessary to complete death packet
- Worksheet for the Report of Fetal Death
- Eligible for Certificate of Stillbirth, if requested by patient
- Call OMI (505) 272-3053) to notify of IUFD. Collect and report name of investigator that received report to inform Birth Registrar. OMI will send report to Birth Registrar who will report the fetal death to DOH.
- Call (272-3982) or Tiger Connect Birth Registrar and inform of IUFD
If delivered by induction of labor:
- Complete OB Delivery Note
Note template for IUFD.
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For all:
- NOT necessary to complete death packet
- Complete Induced Termination of Pregnancy Form
- Place in the L&D Unit Director mailbox in the RN supervisor office
- Ineligible for Certificate of Stillbirth
For patients covered by Medicaid:
If delivered by IOL:
Note template for induced abortion.
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For all:
- Complete OB Delivery Note
- Complete Death Packet
- Call OMI (505-272-3053) to notify of neonatal death. OMI will complete Death Certificate (required within 48h of time of death)
- Call (272-3982) or Tiger Connect Birth Registrar and inform of neonatal death
If time of death called while on L&D:
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