Deviation in the Standard of Obstetrical Care Due to Lack of Prenatal Screening

Evaluate breaches in the standard of care when determining whether or not there has been a Deviation in the Standard of Obstetrical Care Due to Lack of Prenatal Screening

Answer the following questions to find out if the standard of care was followed for your case.

  • Was a thorough medical history obtained?
    Yes
    No
    Answer unknown
    Why is this important?
    At the first prenatal visit, a careful nutritional, medical, family, gynecologic and obstetric history must be taken to evaluate any conditions that may place the woman and her baby at risk.
    (2012) 39 EPCCOP 1 17-37

  • Did the clinician obtain the patient’s immunization history? Why is this important?
    Answer this question
    
Because of the potentially devastating effects of maternal infection with rubella and varicella, screening for immunity needs to be performed and documented.

    (2012) 39 EPCCOP 1 17-37 



  • Was the patient screened for sexually transmitted diseases? Why is this important?
    Answer this question
    
Many of the sexually transmitted diseases pose a significant risk to the fetus. Early and appropriate maternal screening is the key in minimizing the trans-placental or direct-contact transmission of disease.

    (2012) 206 ESAJOG 6 524.e1-524.e7 



  • Was the patient screened for hypertension? Why is this important?
    Answer this question
    
Hypertension is one of the most common pregnancy complications.

    (2011) 204 ESAJOG 4 336.e1-336.e9 



  • Was a disease-specific genetic screening performed? Why is this important?
    Answer this question
    
Ante-partum genetic screening is an important modality for helping to identify and address conditions putting a pregnancy at high risk.

    (2012) 39 EPCCOP 1 17-37 



  • Was the patient screened for substance abuse? Why is this important?
    Answer this question
    
There is strong evidence regarding the catastrophic effects of alcohol, tobacco and illicit drug use during pregnancy.

    (2012) 39 EPCCOP 1 17-37 



  • Was the patient screened for depression? Why is this important?
    Answer this question
    
Screening ensures early diagnosis and enables pregnant women with psychological problems to be referred for appropriate treatment and care.

    (2009) 25 EMIDWI 4 344-356 



  • Were initial screening tests for gestational diabetes performed? Why is this important?
    Answer this question
    
Gestational diabetes mellitus is defined as glucose intolerance that begins, or is first recognized, during pregnancy.

    (2012) 39 EPCCOP 1 83-94 



  • Was a second trimester ultrasound performed to screen for fetal anomalies? Why is this important?
    Answer this question
    
Ultrasound has been established as a reliable tool for the diagnosis of congenital abnormalities and is an integral part of antenatal care.

    (2012) 88 EARHUD 1 3-8 



  • Were serial ultrasounds performed to screen for intra-uterine growth retardation? Why is this important?
    Answer this question
    
Ultrasound is the “gold-standard” for diagnosing intra-uterine growth retardation.

    (2012) 88 EARHUD 1 3-8 



  • Were screening tests for group B streptococcus performed? Why is this important?
    Answer this question
    
In 2002, the centers for disease control and prevention issued revised guidelines recommending universal prenatal screening for vaginal and rectal group B Streptococcus (GBS) colonization of all pregnant women at 35-37 weeks’ gestation.

    (2007) 197 ESAJOG 4 388.e1-388.e4 



  • Were urine samples obtained at each prenatal visit? Why is this important?
    Answer this question
    
Screening for asymptomatic bacteriuria is required.

    (2012) 39 EPCCOP 1 17-37 



  • Was the patient screened for hematological disorders? Why is this important?
    Answer this question
    
Pregnant women need to be screened for anemia.

    (2012) 39 EPCCOP1 17-37 



  • Was the patient screened for Rh incompatibility? Why is this important?
    Answer this question
    
Blood typing and antibody screening indicate the need to test and prophylactically treat ABO and Rh incompatibility. Women who are Rh(D) negative and may be pregnant with an Rh(D)-positive fetus require prophylaxis with RhoGAM.

    (2012) 39 EPCCOP 1 17-37 



  • With which of the following risk factors for Down syndrome did the patient present? Why is this important?
    Answer this question
    
The ACOG states that a prenatal diagnostic procedure for fetal karyotype, rather than serum screening, should be considered in women of any age who have a high risk of Down syndrome or other fetal aneuploidies.

    (2004) 31 EPCCOP 3 561-582 



  • Was a chorionic villus sampling performed on the patient? Why is this important?
    Answer this question
    
Chorionic vilus is performed routinely between 10 and 12 weeks' gestation when the viability of the embryo is determined easily and the placenta is delineated clearly.

    (2004) 31 EPCCOP 3 561-582 



  • Were screening tests for Down syndrome performed in the second trimester of pregnancy? Why is this important?
    Answer this question
    
Women who are not at high risk in the first trimester screening results are to go on to complete the second trimester portion of the test. Second trimester screening is performed by serum quadruple test markers alpha fetoprotein [AFP], unconjugated estriol [uE3], inhibin A and beta-hCG.

    (2003) 23 ECLLMD 2 395-411 



  • Were the second trimester’s screening tests for Down syndrome abnormal? Why is this important?
    Answer this question
    
Incorporating the screening modalities from the first and second trimesters of pregnancy to generate a patient-specific risk for Down syndrome has been defined as integrated screening. Several combinations of screening techniques have been proposed.

    (2004) 31 EPCCOP 3 561-582 



  • Was amniocentesis performed to diagnose Down’s syndrome? Why is this important?
    Answer this question
    
Amniocentesis usually is performed at approximately 15–18 weeks' gestation.

    (2004) 31 EPCCOP 3 561-582