Deviation in the Standard of Obstetrical Care Resulting in Premature Delivery

Evaluate breaches in the standard of care to determine if there has been a Deviation in the Standard of Obstetrical Care Resulting in Premature Delivery

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

  • With which of the following symptoms did the patient present?(Choose all that apply)
    Abdominal cramps/ menstrual-type cramps
    Low, dull back pain
    Pressure feeling in the pelvis if fetal head has descended
    Vaginal bleeding with loss of mucus plug
    Amniotic leak, rupture of membranes
    Chills, urinary tract symptoms (e.g. dysuria), and diarrhea
    None of the above
    Not elicited
    Answer unknown
    Why is this important?
    Symptomsof labor may not be the same as in labor at term.
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  • With which of the following risk factors did the patient present? (Choose all that apply) Why is this important?
    Answer this question
    
A risk factor is a variable that has a causal association with a disease or disease process; the presence of the variable in an individual or a population is associated with an increased risk of the presence or future development of the disease. Thus, risk factors may be useful for identifying subjects at increased risk for a disease or for a particular outcome that results from a disease process.

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  • Was a medical history obtained? Why is this important?
    Answer this question
    
A complete medical history and carefully focused physical examination serve as the core of the diagnostic process. The information obtained guides the further direction of the patient's evaluation and enables the clinician to make the most judicious use of additional tests.

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  • Was a physical examination performed? Why is this important?
    Answer this question
    
A complete medical history and carefully focused physical examination serve as the core of the diagnostic process. The information obtained guides the further direction of the patient's evaluation and enables the clinician to make the most judicious use of additional tests. 

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  • Which of the following signs of premature delivery did the patient exhibit?(Choose all that apply) Why is this important?
    Answer this question
    
The diagnosis of pre-term labor is generally based upon clinical criteria of regular painful uterine contractions accompanied by cervical changes. The presence of vaginal bleeding and/or ruptured membranes increases the diagnostic certainty.

    (1997) 11 EIDCNA 1 177-201 



  • Did the patient’s uterine membranes rupture prematurely? Why is this important?
    Answer this question
    
Pre-mature Rupture of Membranes (PROM) refers to membrane rupture before the onset of uterine contractions. Pre-term rupture of membranes is the condition when the pregnancy is less than 37 weeks of gestation. 

    (2005) 32 EOGCNA 3 411-428 



  • Was the patient discharged from the medical facility and later found to have symptoms of premature labor? Why is this important?
    Answer this question
    
In threatened or early premature labor, prodromal symptoms may be present. Causes of abdominal pain in pregnancy include: • Chorioamnionitis • Abruptio placentae • Appendicitis • Acute pyelonephritis

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  • Which of the following diagnostic laboratory investigations were performed? (Choose all that apply) Why is this important?
    Answer this question
    
Routine laboratory studies can provide important clues to diagnosis.

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  • Which of the following diagnostic advanced studies were performed?(Chooseall that apply) Why is this important?
    Answer this question
    
Amniotic fluid studies may be useful in women with possible preterm labor. When gestational dates are uncertain (e.g., late prenatal care, fetal size larger than expected for dates, suggesting a more advanced gestation), it may be necessary to use amniotic fluid lung maturity studies to help guide management decisions.

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  • With which of the following was the patient diagnosed? (Choose all that apply) Why is this important?
    Answer this question
    
Bacterial vaginosis is an infection in the vagina caused by certain bacteria that can cause foul-smelling vaginal discharge. The presence of bacterial vaginosis has been associated with pre-term delivery independent of other known risk factors.

    (2000) 27 ECLPER 2 263-283 



  • Which of the following preventive actions were taken? (Choose all that apply) Why is this important?
    Answer this question
    
The goal of treatment therapy should be aimed at preventing preterm birth and to minimize perinatal morbidity and mortality.The patient should be educated regarding the risk of premature labor, to recognize early symptoms and to present for assessment if these symptoms are present. The fetal condition should be optimized in preparation for delivery and the maternal health should be preserved.

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  • Were the risks, benefits and complications of the treatment plan explained to the patient? Why is this important?
    Answer this question
    
The risks and benefits of an expeditious delivery need to be weighed and evaluated by the clinician. The healthcare provider then has a responsibility to inform the mother of their assessment. 

    (2005) 32 EOGCNA 3 411-428 



  • Were antibiotics administered? Why is this important?
    Answer this question
    
Women with preterm labor should be treated with antibiotics to prevent neonatal group B streptococcal infection. 

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  • Was an ultrasound performed? Why is this important?
    Answer this question
    
As ultrasound is an objective and reliable method of accurately measuring cervical length. 

    (2007) 21 EBPCOG 5 831-842 



  • Did the clinician recommend insertion of cervical cerclage? Why is this important?
    Answer this question
    
Short cervical length at 16 to 28 weeks is the cervical change best related to the risk of pre-mature birth. A cervical length below (25 mm) is consistently associated with an increased risk of spontaneous pre-mature birth. Funneling is the protrusion of the amniotic membranes into the cervical canal.

    (2007) 21 EBPCOG 5 831-842 



  • Were tocolytic agents administered to delay delivery? Why is this important?
    Answer this question
    
If the decision to delay delivery is made and the patient has no contraindications, tocolytic therapy should be offered. Tocolytic agents are most beneficial before 32 weeks of gestation and work better in the absence of infection. Effectiveness depends on ripeness and cervical dilatation.

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  • Were antenatal corticosteroids administered? Why is this important?
    Answer this question
    
Glucocorticoids act generally in the developing fetus to promote maturation. In the lung, corticosteroids promote surfactant synthesis, increase lung compliance, reduce vascular permeability, and generate an enhanced response to postnatal surfactant treatment.

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  • Which of the following types of delivery were decided? Why is this important?
    Answer this question
    
A preterm birth is commonly defined as one that occurs after 20 weeks gestation and before the completion of 37 weeks of gestation, regardless of birth weight.

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  • Was an informed consent obtained? 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