ROM

Body

#Rule out rupture of membranes, preterm - Patient reports possible ROM @ ***.  Membranes{Blank multiple:19196}***.
- SSE {DESC; WITH/WITHOUT:18785} evidence of rupture
{Positive Negative:23789::"Negative"} pooling on speculum
{Positive Negative:23789::"Negative"} Nitrazine
{Positive Negative:23789::"Negative"} ferning
- Toco {DESC; WITH/WITHOUT:18785} regular contractions
- SVE ***/***/***
- BSUS {DESC; WITH/WITHOUT:18785} adequate fluid***

Option 1:***
- Discharged home with preterm labor precautions ***

Option 2:***
# PPROM; confirmed by workup
- 12mg Betamethasone IM q24h x 2 doses for pulmonary advancement***
- Latency antibiotics ordered:
- 2g Ampicillin IV q6h x 48h, followed by Amoxicillin 500mg PO TID x 5d***
- 500mg Azithromycin PO once, followed by 250mg PO qd x 6d***
- ***6mg Magnesium Sulfate bolus infusion, followed by 2mg/hr infusion for neuroprotection, given that the patient is likely to deliver within the next 24h***
- ***Tocolysis only indicated if labor develops for the purpose of attempting to give second dose of BMZ. Tocolysis indicated due to effort to withstand labor until second dose of BMZ
50mg Indocin PO loading dose, followed by 25mg q6h for tocolysis***
30mg Procardia loading dose, followed by 10mg q6h for tocolysis***
- NICU consult placed***
- Formal ultrasound ordered***

# FWB
- NST: {reactive/ non reactive/ unknown:24043}
- GBS: {status; positive negative unknown:34698}

The following were reviewed in triage:
[X] Maternal vitals - stable***
[X] Fetal heart rate monitoring - NST reactive***
[X] Toco - ***
[X] SSE - no***evidence of ROM
[X] SVE - ***/***/***
[X] Bedside U/S - confirmed presentation, ***
[X] GBS status: positive***negative***collected***
[X] U/A: wnl***

Yellow *** markers = placeholders you fill in or delete per case.