Peripartum Assessment
Instructions: Check conditions if present, do not check if uncertain or not present
CMQCC High-Risk Checks:
Placenta previa or low lying placenta
Suspected placenta accreta/percreta
Hematocrit less than 30
Active bleeding (greater than show) on admission
Platelet count less than 100,000
Known coagulopathy
CMQCC Medium-Risk Checks:
Previous cesarean delivery or uterine surgery
Multiple gestation
Greater than 4 previous vaginal deliveries
Chorioamnionitis
History of peripartum hemorrhage
Large uterine leiomyoma
Macrosomia (estimated fetal weight > 4 kg)
Morbid Obesity (BMI greater than 35 kg/m^2)
Additional Maternal Antepartum Checks:
Age over 40
Arrhythmia
Asthma
Caucasian race
Cervical cerclage
Chronic hypertension
Diabetes (type I, type II, gestational)
Clinical depression
Endometritis
First delivery
Heart failure
Heart disease (congenital, rheumatic, myocarditis/cardiomyopathy, valve disorder, artificial valves, or other)
Infant renal insufficiency
Lupus
Maternal infertility
Maternal renal abnormality (glomerulonephritis, pyelonephritis, lupus nephritis, nephrotic syndromes, nephrolithiasis, transplant, renal abscess, or other)
Maternal acute renal failure
Placental abruption
Polyhydroamnios
Preeclampsia
Sickle cell trait
Smoking (maternal smoking history)
Urinary tract infection
Additional Maternal Peripartum Checks:
Acute respiratory distress
Acute sickle cell crisis
Cesarean section
Preterm labor
Prolonged labor
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