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February 4th, 2021
Policy Refresher: Delayed Cord Clamping Protocol
Our Delayed Cord Clamping Protocol, created in collaboration with the NICU team, has recently been reviewed and renewed.
The entire protocol is attached below. Here are a couple of highlights, as a refresher:
Timing of Delay:
For preterm infants <37 weeks: After a total of 30-60 seconds, NICU (if present) or baby catcher will say “30 seconds complete” and “60 seconds complete” and OB team will clamp cord and hand infant to NICU team
For infants >37 weeks: typically 30-60 seconds (up to 3 minutes) depending on infant status and need for evaluation or resuscitation
Exclusions:
1. Fetal:
Infant with no tone/movement
IUGR <5%
RBC alloimmunization
2. Maternal
General anesthesia
Abruption/bleeding
Uterine rupture
Uncontrolled DM
Placental incision with c-section
Placenta delivered before infant
Other urgent maternal complication
3. Anomalies
CDH (Diaphragmatic Hernia)
Hydrops
Abdominal wall defect
Other anomaly requiring urgent resuscitation
4. Twins/Multiples
Discordant twins >20%
Monochorionic twins
High order multiple
5. Placental
Velamenous cord insertion
Reverse end diastolic flow
If you have questions or concerns, please contact Courtney Olson-Chen (courtney_olson-chen@urmc.rochester.edu)
BPA for Sterilization/Hysterectomy Form
Dr. Linder has added a new update in his EPIC Posts section.
There is a new BPA in the system that helps remind attendings to sign the government sterilization form for patients undergoing hysterectomy or tubal ligation/salpingectomy and have medicaid/option plans. It will only fire for attendings and only once every 24 hours if not addressed. You can click on the link in the BPA to be taken to the media sectino for easy checking if the form has already been signed/scanned into the system. Please let me know if you have any issues with it.
For a second trick related to this: You can use the Haiku app to capture a clinical photo of the form once you've signed it and that will go right back into media where billing will be able to find it.
Levonorgestrel IUD Insertion for Emergency Contraception
From Dr. Betstadt:
Just wanted to make sure that everyone saw this article published in the NEJM last week. The data shows that LNG IUD is non-inferior to Copper IUD for insertions for EC up to 5 days after unprotected intercourse! This was a very robust, well designed RCT where 711 participants seeking EC were randomized(!) to LNG IUD v. Cu IUD. There was ONE pregnancy in the LNG IUD group and zero in the copper IUD group at one month after insertion. We can now start offering this exciting option to our patients!
Review Quiz