Ob antibiotic labor sub plan_2.20.12

Unique Plan Description: OB Antibiotic Labor Sub Plan
Plan Selection Display: OB Antibiotic Labor Sub Plan
PlanType: Medical
Version: 3
Begin Effective Date: 2/20/2012 14:25
End Effective Date: Current
Available at:
ASHEVILLE SPECI
COPESTONE
McDowell Hosp
Mission Cancer
Mission Hosp
Z-Test
OB Antibiotic Labor Sub Plan
Medications
GBS+/Preterm Labor/PPROM delivery risk
2 g, IVPB, IV, ONCE, Duration: 1 doses Comments: for term +GBS patients (greater than or equal to 37 weeks) begin treatment when patient is in active labor (3cm or greater) Comments: continue until delivery IF PENICILLIN ALLERGIC (no high risk for anaphylaxis)(NOTE)* Ancef 2 g, IVPB, IV, ONCE, Duration: 1 doses Comments: for term +GBS patients (greater than or equal to 37 weeks) begin treatment when patient is in active labor (3cm or greater) Comments: continue until delivery IF PENICILLIN ALLERGIC [High risk for anaphylaxis or GBS susceptible to clindamycin and Comments: for term +GBS patients (greater than or equal to 37 weeks) begin treatment when patient is in active labor (3cm or greater), continue until delivery Comments: for term +GBS patients (greater than or equal to 37 weeks) begin treatment when patient is in active labor (3cm or greater), continue until delivery GBS resistant to Clindamycin or Erythromycin or susceptibility unknown:(NOTE)* Comments: for term +GBS patients (greater than or equal to 37 weeks) begin treatment when patient is in active labor (3cm or greater), continue until delivery Chorioamnionitis Patients
Comments: until delivery. Start at the time of Intrapartum diagnosis of Chorioam- AND, Provider choose one of the fol owing:(NOTE)* Comments: until delivery. Start at the time of Intrapartum diagnosis of Chorioam- For the PCN al ergic patient not at risk for anaphylaxis(NOTE)* Comments: until delivery. Start at the time of Intrapartum diagnosis of Chorioam- For the Chorioamnionitis Patient that is PCN al ergic AND at High risk for Anaphylaxis or is GBS positive and susceptible to clindamycin (Cleocin)(NOTE)* Comments: until delivery. Start at the time of Intrapartum diagnosis of Chorioam- For the Chorioamnionitis Patient that is PCN al ergic AND at High risk for Anaphylaxis or is GBS positive and resistant to clindamycin (Cleocin)(NOTE)* Comments: until delivery. Start at the time of Intrapartum diagnosis of Chorioam- *Report Legend:
DEF - This order sentence is the default for the selected order OB Antibiotic Labor Sub Plan Reference Text
Patient with Preterm Labor or PPROM who are at risk for imminent delivery.
Discussion among the MFMs and neonatologists has generated new recommendations
for GBS evaluation and prophylaxis in women who present with preterm labor or
PPROM who are at risk for imminent delivery. These are adapted from the CDC sample
algorithm for women with threatened preterm delivery. Please note the need for Ante-
partum cultures prior to initiation of antibiotic therapy in certain patient populations such
as those with PROM.
Since we use broader-spectrum antibiotics to prolong the latency period, a GBS culture
should be obtained before initiating therapy and the results used to guide Intrapartum
management. This means antibiotics to prolong latency wil be continued for the usual
duration even if the GBS culture is negative.
* Penicil in (Ampicil in at MMH, See SPECIAL CONSIDERATIONS below) should be continued for a total of at least 48 hours, unless delivery occurs sooner. At the physi-cian’s discretion, antibiotic prophylaxis may be continued beyond 48 hours in a GBS culture-positive woman if delivery has not yet occurred. For women who are GBS culture-positive, antibiotic prophylaxis should be reinitiated when labor likely to lead to delivery occurs or recurs.
If delivery has not occurred within 4 weeks, a vaginal and rectal GBS screening
culture should be repeated and the patient should be managed as described in the
algorithm, based on the result of the repeated culture.
Prevention of early-onset group B streptococcal disease in newborns. ACOG Commit-tee Opinion NO. 279. American Col ege of Obstetricians and Gynecologists. Obstet Gynecol 2002;100:1405-12. (Reaffirmed 2009) Schrag S, Gorwitz R, Fultz-Butts K, Schuchat A. Prevention of Perinatal group B strep-tococcal disease. Revised guidelines from CDC. MMWR Recomm Rep 2002;51(RR-11):1-22.

Source: http://cdn4.mission-health.org/sites/default/files/document-library/1877_0.pdf