Post-Partum Rounds Overview

1. Meditech→ people icon below your name→edit coverage-→ Providers

2. Print list of post-partum patients (remove the private OB patient from the list before printing {any
provider not associated with our residency} (Drs. White, Vagovic, Carbiener, Esquival, Tyser,
Baldwin, etc))
3. Halifax Shortcuts→OB TraceVue→ compare patient list with patients in PURPLE (purple= post-
partum) List will also give you some info but double check with Meditech as not always accurate.
Care for Women= our OB clinic
4.
5. Pre-round prep: Get info below for each patient Extra Info:
- GPs (G1P011 etc) C-section→ can stay up to 3 days →
- Post-op/ post-partum day # get sent home with Percocet as
- Delivery complications and type of delivery needed (no more than 14 pills) and
- Doctor seen for prenatal care stool softener (Senna). Must print
- GBS status Percocet script and have OB
- Hgb/Hct pre and post op attending sign it.
- Meds/ medical problems (gestational HTN, pre-
eclampsia etc) - C-section: incision dressing off 24-
- review vitals overnight/since delivery (BP, Temp, 48 hrs after C-section. Unless it’s
HR) silvadene dressing, which stays on
for 1 week
6. Patient Rounding:
Vaginal→ can stay up to 2 days
Ask all moms this:
** Dr. Pierre-Loui requires, others
- Eating/drinking usually do not
- N/V/ CP/ SOB/fever
- BM/pass gas/urinating
- Breast/formula feeding
- Leg swelling
- Able to walk without issue
- Interested in birth control? Pt can be given depo before leaving or BC script (Miconor for
breastfeeding Moms) so make sure to offer both options. If breast feeding, discuss the
theoretical/very small risk of milk supply decreasing with dept shot. Document this in your note.
IUD or Nexplanon must be placed by OB/physician. If patient sees a midwife for prenatal care
they can’t due this. Can refer to our GYN clinic if needed.
 - If appropriate: you ready to be discharged?-- typically for POD#2 patients because they can
choose to stay for 3 days post-op.
- Discuss pelvic rest for 6 weeks. No sexual activity, tampon use, nothing inserted into vagina for 6
weeks. Even for C-section patients.
- If C-section: advise incision check with primary OB in 1 week after d/c
- If gestational HTN, Pre-eclampsia: advise BP check in 3-5 days after d/c

PE:
-heart/lungs
- thyroid exam→ nontender, non-enlarged, no nodules
-Breast exam→nontender, no skin changes, abnormal nipple discharge, nodules (need chaperone, ask nurse)
-Abdomen→ nontender, incision dry, clean, intact, document staples if present
- LE→ no leg swelling (probably will have especially if received IV fluids during C-section), calf tenderness

7. Meet with Attending and Present items from 4 & 5. Some attendings may want you to present
more/less but best to have it all just in case.

8. Discharge Order: Some may not need this if its like post op day 1
Top of page→ discharge
Patient Dispo: home
Give the Percocet/Senaa for post cesarean patients → must print the Percocet script (change destination to
print) and have attending sign Percocet order and put in their chart at nurse’s station/computer are
Prescribe birth control pills or depo shot if patients agree to it. Depot order in orders section of Meditech
(Depo-Prover inj IM) and may be administered prior to d/c.

9. Progress Note
Documents at top→ OB Post Op Progress note (c-section) or OB Post-Partum Progress note (vaginal)
-Star these so you can get back easily to them!
-Use progress note template below (I emailed to you)
-Complete/ Sign and put your attending as co-signer.

OB PostPartum HPI

Patient is a []-year-old G[] P[] delivered at [] weeks and [] days. Patient is postpartum day [] after [].
Patient's pain is well-controlled. Patient reports eating and drinking without any nausea or vomiting.
Patient reports minimal bleeding. Patient has passed gas but no bowel movements. Patient is walking
without lower extremity pain or shortness of breath. Patient reports desire for contraception and
breast-feeding.

OB Postpartum exam
GENERAL: Well-nourished, well-appearing, well-developed patient in no acute distress.
NECK: Nontender. No palpable thyroid nodules. No thyroid enlargement.
BREAST: No tenderness on exam. No erythema. No palpable masses or areas of induration.
CARDIOVASCULAR: Regular rate and rhythm without murmurs, gallops, or rubs.
RESPIRATORY: Breath sounds equal bilaterally without wheezes, rhonchi, or rales. No accessory muscle
use.
ABDOMEN/GI: Abdomen soft, nondistended, no guarding.
Fundus: Firm, mild tenderness at umbilicus, no acute abdomen.
Incision: Clean, dry, intact without erythema, drainage, active bleeding, or swelling.
EXTREMITIES: No cyanosis or edema, non-tender, without signs of DVT.
NEUROLOGICAL: No clonus. 2+ DTRs of bilateral upper and lower extremities.

OB Post-Op Plan
Plan:
-Afebrile with
-Continue routine postpartum care.
-Motrin and Percocet as needed for pain.
-Encouraged OOB. Advised pelvic rest for 6 wks.
-Informed patient that she needs an incision check with obstetrician within 7 days and a f/u appt. with
an obstetrician in 6 wks.
-Contraception:
-Anticipate discharge [ ]