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IUFD Checklist – TO BE PLACED ON PATIENT’S CHART

H&P

__Signs/Symptoms infection __Signs/Symptoms preeclampsia
__Signs/Symptoms IHC __ROM
__Bleeding __Previous Demise
__Trauma  

 
Labs

__CBC __T&S __KB
__Fibrinogen __UDSv __RPR
__Karyotype (amnio, CVS) __Direct Coombs __Glucose
__LFTs __Thyroid panel __CMV
__Toxoplasmosis __Parvovirus __Antiphospholipid antibodies
__ANA    

 
Placenta

__If fetus to Greenwood, placenta to surgical path

__If no autopsy, placenta to surgical path

__If GHS autopsy, placenta to forensic path with fetus

__If suspicious for infection, specimen to microbiology for culture

 
Autopsy

__GHS forensic pathology

__Karyotype specimen                    Blood                      Amniotic fluid                      Tissue                       Placenta

__Karyotype offered but declined

 
Referrals

__Social Services

__Chaplain

__Genetics 250-7944

Follow-up – 2 and 6 weeks at OB/Gyn  Center  (455-8897); Fax IUFD checklist to nurses fax  (455-6598)