Sample Orders for Fetal Demise
1. Allergies:
2. Admit or OBS to: [ ] Antepartum [ ] Labor and Delivery
3. Admitting Diagnoses: Fetal demise
4. Secondary Diagnoses  
5. Condition:  [ ] Stable [ ] Fair [ ] Serious [ ] Critical
6. VS:   [ ] Per routine [ ] Every 4 hours
7. Fetal Monitoring [ ] Tocodynamometer
8. Activity: [ ] Bedrest with bathroom privileges
9. Nursing: [ ] Grief Management protocol
10. Diet: [ ] NPO [ ] Clear liquids [ ] Regular diet [ ] Other______________________
11. IV: [ ] Heplock [ ] D5LR TRA 125 cc/hr [ ] Other_____________________
12. Labs: Maternal Blood:
  [X]Random glucose, CBC with platelet count, PT, PTT, fibrinogen, antibody screen,
VDRL, Kleihauer-Betke, urine toxicology screen.
[ ] Thyroid function testing
[ ] CMV titer (IgM and IgG)
[ ] Parvovirus antibody
[ ] Lupus anticoagulant and anticardiolipin antibody
[ ] Factor V Leiden mutation
[ ] Antithrombin III
[ ] Protein C and Protein S
[ ] Serum creatinine
[ ] Liver function tests
[ ] Viral cultures
[ ] Bacterial cultures (Alert the lab that Campylobacter and Listeria are in the differential)
[ ] Other _____________________
 
Fetal Blood
[ ] Cytogenetics (1-10 ml in green top tube)
[ ] Bacterial culture at least 1 ml
[ ] Serology (PCR if available) for STORCH (syphilis, toxoplasma, other (e.g. parvovirus), rubella, CMV, HSV)
[ ] CBC
 
13. Meds: [X]Rhogam if Rh negative
15. Other: [ ] If complete abortion has not occurred within 1 hour of
expulsion of the fetus, the patient will be taken to the OR for curettage.
[ ] Delivery pack at bedside with pathology container.
[ ] Placenta to pathology.
[ ] Consent for tissue samples
[ ] Fascia lata to pathology
[ ] Consent for autopsy.
[ ]Consent for photographs
[ ] MRI fetus
[ ] AP plain radiograph of the whole infant's body