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INCIDENCE OF PPROM Preterm PROM-defined as PROM prior to 37 weeks of gestation complicates 2% to 4% of all singleton 7% to 20% of twin pregnancies. It is the leading identifiable cause of premature birth ( 30%) accounts for approximately 18% to 20% of perinatal deaths in the United States. Dr. Sharda Jain Dr. jyoti Bhasker
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Pain management of orthopedic surgery patients is being impacted by the changes in health care regulation and reimbursement. There is a need for safer, more effective pain management pathways that can provide opportunities for early discharge without increasing the risk of readmissions or compromising outcomes. Current pain management strategies for joint replacements, spine surgery and outpatient knee and shoulder procedures will be examined from clinical, safety, satisfaction and cost perspectives. The process of implementing and evaluating these pathways will also be discussed. Nina Whalen will demonstrate how she evaluated, developed and improved pain management pathways for patients. These pathways include: – Multimodal pain management for total joint and spine – Peripheral nerve block utilization for inpatients and outpatients – Customized pain pathways for special populations – The use of intraoperative tissue infiltration with medications as a primary pain management strategy in joint replacement surgery About The Speaker: Nina Whalen, RN, APN-C, has over 30 years of experience as a nurse practitioner in orthopedic medicine. She has been involved in every phase of patient care at both the clinic and tertiary care levels. In the 1990’s she created and worked in a nurse practitioner hospital program at Presbyterian St Luke’s hospital that provided 24 hour coverage for the needs of hospitalized orthopedic surgery patients. She has worked in research and has co-authored publications in the areas of sports medicine and total joint. She is currently the manager of clinical outcomes at OrthoIndy Hospital (formerly Indiana Orthopaedic Hospital) which is a 38 bed, physician owned, orthopedic specialty hospital in Indianapolis.
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INCIDENCE OF PPROM Preterm PROM-defined as PROM prior to 37 weeks of gestation complicates 2% to 4% of all singleton 7% to 20% of twin pregnancies. It is the leading identifiable cause of premature birth ( 30%) accounts for approximately 18% to 20% of perinatal deaths in the United States. Dr. Sharda Jain Dr. jyoti Bhasker
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Induction summary
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SUMMARY RECOMMENDATIONS AND
CHANGES TO INDUCTION GUIDELINES INPATIENT ( IP ) & OUPATIENT ( OP ) October 2010
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DILATION SCORE
0 0 cm 2 1-2 cm 4 3-4 cm 6 >4 cm CERVICAL LENGTH SCORE By digital PALPATION 0 3 cm 1 2 cm 2 1 cm 3 0 cm STATION SCORE In relation to spines 0 -3 1 -2 2 -1/O 3 + 1/+2
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