Deviation in the Standard of Obstetrical Care During Labor & Delivery Resulting in Hypoxic Brain Injury, Fetal Demise

Evaluate breaches in the standard of care when evaluating whether or not there was a breach in the standard of case when there was a Deviation in the Standard of Obstetrical Care During Labor & Delivery Resulting in Hypoxic Brain Injury, Fetal Demise

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

  • Did the medical history reveal any of the following? (Choose all that apply)
    Still birth
    Intrauterine growth retardation
    Oligohydroamnios
    Polyhydroamnios
    History not elicited
    Maternal epilepsy
    Diabetes mellitus
    Hypertension
    Answer unknown
    Why is this important?
    Increased ante partum monitoring is warranted for women at increased risk for fetal death, including those with a history of stillbirth, intrauterine growth restriction, oligohydramnios or polyhydramnios, multiple gestation, rhesus sensitization, hypertensive disorders, diabetes mellitus or other chronic maternal disease.
    (2009) 23 EBPCOG 3 357-368

  • Did the mother develop any systemic infection during pregnancy? Why is this important?
    Answer this question
    
Viral, bacterial, and parasitic infections can have a significant impact on the mother, fetus, or both.

    (2004) 81 EARHUD 1 27-34 



  • Were fetal congenital anomalies undetected? Why is this important?
    Answer this question
    
Congenital anomalies are a major cause of stillbirths, neonatal death, acute illnesses and long-term morbidity. Evaluation of the health of the fetus and screening for birth defects is an important part of prenatal care.

    (2005) 193 ESAJOG 6 1923-1935 



  • Was fetal growth retardation undetected? Why is this important?
    Answer this question
    
One of the most important factors of intrauterine growth restriction is placental insufficiency, which is responsible for growth retardation and fetal hypoxia.

    (2010) 86 EARHUD 6 339-344 



  • Was the size of the baby miscalculated? Why is this important?
    Answer this question
    
Macrosomia complicates labor and delivery.

    (2007) 17 EOBGRM 2 58-61 



  • Which of the following events were experienced? (Choose all that apply) Why is this important?
    Answer this question
    
Various studies have demonstrated that increased risk in maternal and neonatal morbidity occur with increased lengths of time from the rupture of membranes to the delivery of the baby. It is recognized that, 18 hours duration constitutes a prolonged time interval between rupture and birth.

    (2010) 86 EARHUD 6 339-344 



  • Which of the following procedures were performed? (Choose all that apply) Why is this important?
    Answer this question
    
The normal range of baseline fetal heart rate at term is 110-160 beats/min. Tachycardia (greater than 160 beats/min) is associated with early fetal hypoxia. Fetal bradycardia (lesser than 110 beats/min) may be normal (e.g., 105-110 beats/min) but may occur with fetal hypoxia.

    (2009) 56 EPDCNA 3 489-504 



  • Which of the following outcomes were documented? (Choose all that apply) Why is this important?
    Answer this question
    
Variable decelerations occur as a result of cord compression. Variable decelerations commonly appear during the end of the active phase or early second stage of labor.

    (2009) 56 EPDCNA 3 489-504 



  • Which of the following interventions were taken for abnormal fetal heart tracings? (Choose all that apply) Why is this important?
    Answer this question
    
If the fetal heart rate tracing is abnormal, interventions such as position changes, maternal oxygenation, and intravenous fluid administration may be used.

    (2005) 15 ECOBGY 1 18-24 



  • Which of the following complications were documented? (Chooose all that apply) Why is this important?
    Answer this question
    
Intra-partum events that are likely to cause complete disruption of maternal-fetal gas exchange and can lead to neonatal encephalopathy are cord prolapse and placental abruption. 




  • Which of the following did the clinician detect? (Choose all that apply) Why is this important?
    Answer this question
    
Repetitive variable decelerations suggest umbilical cord compression, especially in the presence of oligohydramnios or amniotomy. 

    (2005) 15 ECOBGY 1 18-24 



  • Did the clinician perform an emergency cesarean section? Why is this important?
    Answer this question
    
Any obstetric emergency requires an expeditious delivery, reducing the incidence of fetal hypoxia and fetal demise.

    (2008) 35 ECLPER 3 549-559 



  • Was a pediatrician or an anesthesiologist present in the labor room or operation room at the time of delivery? Why is this important?
    Answer this question
    
Once priorities and goals have been agreed on, referral to the appropriate professionals must be made in a timely manner. To deliver care requires a coordinated approach that allows sharing of skills and expertise. The skills of members from all professional disciplines must be utilized to reduce the likelihood of fetal hypoxia.

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  • Which of the following interventions were necessary? Why is this important?
    Answer this question
    
At birth, the survivor of a significant intrapartum hypoxic insult may present with respiratory depression, cyanosis, poor responsiveness, hypotonia and bradycardia (low Apgar score). Neonatal resuscitation is the priority and results in rapid clinical improvement. 

    (2007) 132 EJOBGY 1 3-7 



  • Which of the following did the clinician perform? (Choose all that apply) Why is this important?
    Answer this question
    
Adequate precautions to reduce an abnormally elevated maternal temperature and to treat suspected infection are required to reduce the vulnerability of the baby from hypoxic injury

    (2004) 81 EARHUD 1 27-34 



  • Which of the folowing did the clinician administer? Why is this important?
    Answer this question
    
Corticosteroids are used in preterm labor to increase fetal surfactant and to accelerate fetal lung maturity. They have been shown to be beneficial in reducing neonatal death, respiratory distress syndrome (RDS), necrotizing enterocolitis, cerebrovascular hemorrhage and neonatal intensive care admissions.

    (1997) 11 EIDCNA 1 177-201 



  • Which of the following was initiated? (Choose all that apply) Why is this important?
    Answer this question
    
Amniofusion is sometimes performed in conjunction with intrauterine pressure monitoring to increase intrauterine fluid levels, thereby alleviating cord compression and abnormal fetal heart rates associated with oligohydramnios or clearing thick meconium staining.

    (1999) 26 EOGCNA 2 259-274 



  • Was the cord gas evaluated? Why is this important?
    Answer this question
    
A useful way of assessing birth asphyxia in a depressed newborn is to analyze the umbilical cord arterial blood gases.

    (2004) 18 EBPCOG 3 457-466 



  • What was the value of the cord gas? Why is this important?
    Answer this question
    
The intrapartum acid-base status of the fetus is an important component in establishing the link between intrapartum events and neonatal condition. The analysis of cord blood gases from the umbilical artery is believed to be the best representation of the fetal acid-base status immediately before birth. Blood gas analysis is able to objectively confirm or exclude the presence of damaging acidemia.

    (2007) 34 ECLPER3 451-459