OB April 2012

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Title
Iowa Statewide
Guidelines for Perinatal
Services

Section 1: OB
Hemorrhage
OB Hemorrhage Toolkit
(California Maternal
Quality Care
Collaborative [CMQCC])

Source

Description

http://www.idph.state.ia.us/hpcdp/common
/pdf/8th_edition_guidelines.pdf

This document serves as a guideline for perinatal

services in Iowa combining important information
regarding Iowas regionalized perinatal health
system, guidelines for care, quality improvement
and Iowa Code impacting care of Iowas moms and
babies.

http://www.cmqcc.org/ob_hemorrhage

A comprehensive toolkit from the California

Maternal Quality Care Collaborative (CMQCC) for
health care providers to improve readiness,
recognition, response and reporting of
hemorrhage.
Equipment list for an OB hemorrhage cart
designed to treat vaginal/cervical lacerations and
provide the instruments for uterine tamponade and
uterine/ovarian artery ligation.

OB Hemorrhage: Carts,
Kits, Trays (CMQCC)

http://www.npic.org/Links/Postpartum_Hemorrha
ge_Cart.pdf

Section 2: Induction
and Augmentation
Elective Induction and
Augmentation Bundles
(Institute for Healthcare
Improvement [IHI])

http://www.ihi.org/knowledge/Pages/Changes/Ele
ctiveInductionandAugmentationBundles.aspx

A bundle is a group of evidence-based

interventions related to a disease process that,
when executed together, result in better outcomes
than when implemented individually. Successful
implementation of the bundles is based on the all
or nothing strategy, under which teams must
comply with all components of the bundle unless
medically contraindicated.

http://www.cmqcc.org/_39_week_toolkit

A Quality Improvement Toolkit, Elimination of Nonmedically Indicated (Elective) Deliveries Before 39

Weeks Gestational Age, to decrease deliveries
before 39 weeks and to help determine and
disseminate best practices for prevention of early
deliveries, and to outline the most effective
strategies for health care providers in
implementing those practices.

Section 3: Early
Elective Deliveries
<39 Weeks Toolkit
(CMQCC)
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Title
Electronic Alerts,
Patient Education, and
Performance Reports
Improve Adherence to
Guideline Designed to
Reduce Early Elective
Inductions (U.S.
Department of Health &
Human Services, Agency
for Healthcare Research
and Quality [AHRQ])
Eliminating Elective
Deliveries Prior to
39(+0) Weeks
(California Hospital
Patient Safety
Organization)
Safe Deliveries:
Reducing Elective
Delivery Prior to 39
Weeks (Washington
State Hospital
Association)
Measure Information
Form (The Joint
Commission)

Source

Description

http://www.innovations.ahrq.gov/content.aspx?
id=3161

Intermountain Healthcare adapted an existing

guideline and developed associated care processes
to ensure that pregnant women undergo early
elective inductions (defined as before the baby
reaching a gestational age of 39 weeks) only when
medically necessary.

http://www.chpso.org/perinatal/thecase.pdf

A presentation by the California Hospital Patient

Safety Organization outlining the evidence for
eliminating this practice.

http://www.wsha.org/0398.cfm

A description of the work of the Washington State

Hospital Association to reduce elective deliveries
before 39 completed weeks of gestation.

http://manual.jointcommission.org/releases/TJC2
010A/MIF0166.html

Specifications for The Joint Commissions NQFendorsed measure for elective delivery.

http://shoulderdystociainfo.com/index.htm

A comprehensive Web site with an extensive

bibliography on shoulder dystocia.

http://www.nnepqin.org/site/page/vbac

The products of a collaborative process in Northern

New England to restore the practice of Vaginal
Birth After C-Section (VBAC) safely. This includes
VBAC guidelines, consent for birth after a Csection, and birth choices after a C-section.

Section 4: Shoulder
Dystocia
Supporti
ng

Enhance
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Shoulder Dystocia:
Facts, Evidence and
Conclusions (Dr. Henry
Lerner)
Section 5: VBACs
VBAC Project (Northern
New England Perinatal
Quality Improvement
Network [NNEPQIN])
Section 6: Simulation
of OB Emergencies

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HPH

HPH

Core

Title

Source

Description

Emergency C-Section
Toolkit (NNEPQIN)
Preparing for Clinical
Emergencies in
Obstetrics and
Gynecology (American
Congress of
Obstetricians and
Gynecologists [ACOG])

http://www.nnepqin.org/site/page/emergency

Rehearsing Team Care

for Relatively Rare
Obstetric Emergencies
Leads to Improved
Outcomes (AHRQ)
Crisis Management
Simulation Course
Receives Positive
Reviews, Enhances
Communication and
Teamwork Among Labor
and Delivery
Practitioners During
Crises (AHRQ)
Section 7: Magnesium
Sulfate for
Neuroprotection
Magnesium Sulfate
Before Anticipated
Preterm Birth for
Neuroprotection (ACOG)

http://www.innovations.ahrq.gov/content.aspx?
id=2463

http://www.acog.org/Resources_And_Publications
/Committee_Opinions/Committee_on_Patient_Saf
ety_and_Quality_Improvement/Preparing_for_Cli
nical_Emergencies_in_Obstetrics_and_Gynecolog
y

http://www.innovations.ahrq.gov/content.aspx?
id=265

http://www.acog.org/Resources_And_Publications
/Committee_Opinions/Committee_on_Obstetric_P
ractice/Magnesium_Sulfate_Before_Anticipated_
Preterm_Birth_for_Neuroprotection

A toolkit for hospitals to use to improve their local

emergency Caesarean delivery process.
ACOG Committee Opinion. Patient care
emergencies may periodically occur at any time in
any setting, particularly the inpatient setting. To
respond to these emergencies, it is important that
obstetrician/gynecologists prepare themselves by
assessing potential emergencies that might occur,
creating plans that include establishing early
warning systems, designating specialized first
responders, conducting emergency drills, and
debriefing staff after actual events to identify
strengths and opportunities for improvement.
Having such systems in place may reduce or
prevent the severity of medical emergencies.
Multidisciplinary teams at the University of Kansas
Hospital seek to improve the handling of obstetric
emergencies by rehearsing team responses to
emergency situations that can occur during a
delivery.
Labor and Delivery Crisis Resource Management
courses are two (introductory and advanced)
seven-hour, simulation-based teamwork classes for
labor and delivery clinicians.

ACOG Committee Opinion. Available evidence

suggests that magnesium sulfate given before
anticipated early preterm birth reduces the risk of
cerebral palsy in surviving infants. Physicians
electing to use magnesium sulfate for fetal
neuroprotection should develop specific guidelines
regarding inclusion criteria, treatment regimens,
concurrent tocolysis, and monitoring in accordance
with one of the larger trials.

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Title
Section 8: Improve
Teamwork &
Communication
TeamSTEPPS:
National
Implementation (AHRQ)
Section 9: VTE in OB
Prevention and
Treatment of Venous
Thromboembolism (VTE)
in Obstetrics (SOGC)

Source

Description

http://teamstepps.ahrq.gov/

An evidence-based teamwork system to improve

communication and teamwork skills among health
care professionals.

http://www.sogc.org/guidelines/public/95E-CPGSeptember2000.pdf

A 2000 clinical practice guideline reviewed and

approved by the Maternal Fetal Medicine
Committee and the Council of the Society of
Obstetricians and Gynaecologists of Canada.
Identifies risk factors for venous thromboembolism
(VTE) in the peripartum period and provides
guidelines for
risk assessment and thromboprophylactic
measures for VTE in pregnant women. Guidelines
for diagnostic testing and for
acute and long-term treatment of VTE are also
provided.

http://www.marchofdimes.com/TIOPIII_FinalManu
script.pdf

A March of Dimes publication and call to action

filled with examples of promising and successful
initiatives designed to improve the quality of
perinatal care at hospitals and healthcare systems
across the country.

http://www.ismp.org/tools/highalertmedications.
pdf

A list of medications that bear a heightened risk of

causing significant patient harm when used in
error, including magnesium sulfate and oxytocin.

http://www.acog.org/Resources_And_Publications
/Committee_Opinions/Committee_on_Patient_Saf
ety_and_Quality_Improvement/Patient_Safety_in
_Obstetrics_and_Gynecology

ACOG Committee Opinion. Since publication of the

Institute of Medicines landmark report To Err is
Human: Building a Safer Health System, emphasis
on patient safety has steadily increased.
Obstetrician-gynecologists should continuously
incorporate elements of patient safety into their
practices and also encourage others to use these
practices.

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Section 10: OB
Adverse Events
Toward Improving the
Outcome of Pregnancy
III: Enhancing Perinatal
Health through Quality,
Safety and Performance
Initiatives (March of
Dimes)
ISMP's List of High-Alert
Medications (Institute
for Safe Medication
Practices)
Patient Safety in
Obstetrics and
Gynecology (ACOG)

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Title
ACOG (American
College of Obstetricians
and Gynecologists)
AWHONN (Association
of Women's Health,
Obstetric and Neonatal
Nurses)
National Quality Forum,
National Voluntary
Consensus Standards for
Perinatal Care 2008

Source

Description

http://www.acog.org/
http://www.awhonn.org/awhonn/

http://www.qualityforum.org/Publications/2009/0
5/National_Voluntary_Consensus_Standards_f

or_Perinatal_Care_2008.aspx

Home page of a comprehensive Web site for ACOG,

a membership organization for obstetricians and
gynecologists.
Home page of a comprehensive website for
AWHONN, a membership organization for obstetric
and neonatal nurses.
A National Quality Forum abridged consensus
report on perinatal standards. The full document is
available for a fee.