Deviation in the Standard of Obstetrical Care During a Cesarean Section

Evaluate breaches in the standard of care when evaluating whether or not there was a Deviation in the Standard of Obstetrical Care During a Cesarean Section

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

  • With which of the following risk factors did the patient present? (Choose all that apply)
    Prior large for gestational age babies
    Shoulder dystocia
    Gestational diabetes mellitus
    Instrumental delivery
    Dysfunctional labor
    Previous cesarean section
    Answer unknown
    None elicited
    Why is this important?
    Risk factors are useful for identifying patients at increased risk for a disease or for a particular outcome that results from a disease process.
    Click here for additional information at ClinicalKey.com

  • Did the clinician identify and document any of the following during the course of pregnancy? (Choose all that apply) Why is this important?
    Answer this question
    The most prevalent maternal medical risk factors that are associated with primary and repeat cesarean delivery are anemia, diabetes mellitus and hypertension.
    (2011) 38 ECLPER 2 297-309

  • Which of the following clinical conditions were present? (Choose all that apply) Why is this important?
    Answer this question
    The indications for primary cesarean delivery include breech presentation, dystocia (abnormal or difficult labor), fetal distress or maternal medical and obstetric risk factors.
    (2004) 190 ESAJOG 1 10-19

  • Was an emergency cesarean section performed? Why is this important?
    Answer this question
    An emergency cesarean delivery is defined as a cesarean delivery that is performed after labor has begun.
    (2012) 36 ESMPER 5 384-389

  • Did the clinician obtain and document a detailed informed consent? Why is this important?
    Answer this question
    The laws of most states require that clinicians obtain informed consent before providing treatment.
    (2011) 23 EOMSCA 3 475-484

  • When was the patient’s last full meal? Why is this important?
    Answer this question
    The gastric volume predisposing a patient to aspiration is 30 ml or more.
    (2004) 18 EBPRCA 4 719-737

  • Did an anesthesiologist evaluate the patient prior to the procedure? Why is this important?
    Answer this question
    Consultation with an anesthesiologist prior to the procedure is necessary to evaluate the patient and to determine if general anesthesia or regional anesthesia (spinal or epidural) is to be used.
    (2005) 14 IJOBAN 2 147-158

  • Did the clinician perform baseline laboratory tests? Why is this important?
    Answer this question
    Laboratory investigations are necessary to assess the overall status of the patient. Baseline blood investigations must include complete blood count (CBC), type and cross match, and coagulation studies. Blood gases are necessary to determine the patient’s respiratory status.
    Click here for additional information at ClinicalKey.com

  • Did the clinician anticipate the need for a possible blood transfusion? Why is this important?
    Answer this question
    Pregnancy itself may cause anemia. Additional predisposing factors for transfusion include placental abnormalities, eclampsia, general anesthesia and a history of multiple cesarean deliveries.
    (2005) 14 IJOBAN 2 147-158

  • Did the patient receive prophylactic antibiotics? Why is this important?
    Answer this question
    In order to reduce the risk of post-operative infection, a single intravenous dose of a narrow spectrum antibiotic needs to be administered pre-operatively to all women undergoing cesarean delivery.
    (2005) 14 IJOBAN 2 147-158

  • Did the patient with a high risk of thromboembolism receive prophylactic anti-coagulants? Why is this important?
    Answer this question
    For women undergoing cesarean delivery at high risk of venous thrombo-embolism, both mechanical prophylaxis and pharmacological prophylaxis are recommended. Pharmacologic prophylaxis is begun 6 to 12 hours postoperatively, after concerns for hemorrhage have decreased.
    (2005) 14 IJOBAN 2 147-158

  • Was the fetal heart rate monitored and documented prior to the procedure? Why is this important?
    Answer this question
    Guidelines on electronic fetal heart monitoring recommend that where acute fetal compromise is suspected as in severe fetal bradycardia, delivery must occur as soon as possible.
    (2005) 14 IJOBAN 2 147-158

  • Was a Foley catheter inserted? Why is this important?
    Answer this question
    In non-emergency situations, a Foley catheter may be placed after adequate anesthesia. The catheter facilitates bladder drainage during the procedure and for the subsequent 12-24 hours.
    (2005) 14 IJOBAN 2 147-158

  • Were the vital signs monitored before and during the administration of anesthesia? Why is this important?
    Answer this question
    The mother's blood pressure, pulse, and oxygen saturation needs to be monitored throughout the procedure, starting before provision of anesthesia.
    (2005) 14 IJOBAN 2 147-158

  • Which of the following intra-operative complications did the patient experience? (Choose all that apply) Why is this important?
    Answer this question
    Severe hypotension with bradycardia can occur after administration of anesthesia. Methods commonly used to prevent or treat hypotension, include fluid pre-loading, the use of medication administration, positioning and vasopressor therapy.
    (2008) 17 IJOBAN 4 292-297

  • Did the clinician call for the assistance of a pediatrician or a neonatologist? Why is this important?
    Answer this question
    International guidelines on neonatal resuscitation and pediatric care state that an appropriately trained practitioner is to be present at all births by cesarean section.
    (2005) 193 ESAJOG 3 599-605

  • Did the infant sustain any physical injuries during the delivery? Why is this important?
    Answer this question
    Extreme care and precision is needed to ensure that instrument lacerations are avoided. This complication is more likely if there has been rupture of membranes or if there is oligohydramnios.
    (2003) 21 EMDCNA 3 679-693

  • Post-operatively, was documentation made of the mother’s vital signs, urinary output, bowel sounds and surgical wound condition? Why is this important?
    Answer this question
    Post-operative care includes taking vital signs every 15 min for the first 2 hrs, monitoring urine output hourly, palpating the fundus and expressing the clots immediately, examining the surgical wound for signs of infection and auscultating the abdomen for the return of bowel sounds.
    (2005) 14 IJOBAN 2 147-158

  • Which of the following post-operative complications did the patient experience? (Choose all that apply) Why is this important?
    Answer this question
    The infected wound is tender, inflamed, indurated, or drains purulent material. Also it is recommended that wound infection be suspected in febrile patients.
    (2012) 39 EPCCOP 1 145-165