Case Studies November 19-20, 2009 Medical Legal Issues in Obstetrics Practice Ronald S. Gibbs, MD...
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Case Studies Case Studies November 19-20, 2009 November 19-20, 2009 Medical Legal Issues in Obstetrics Practice Medical Legal Issues in Obstetrics Practice Ronald S. Gibbs, MD Ronald S. Gibbs, MD Professor, Department of Obstetrics and Professor, Department of Obstetrics and Gynecology Gynecology Associate Dean, Continuing Medical Education Associate Dean, Continuing Medical Education
Transcript of Case Studies November 19-20, 2009 Medical Legal Issues in Obstetrics Practice Ronald S. Gibbs, MD...
Case StudiesCase Studies
November 19-20, 2009November 19-20, 2009Medical Legal Issues in Obstetrics PracticeMedical Legal Issues in Obstetrics Practice
Ronald S. Gibbs, MDRonald S. Gibbs, MDProfessor, Department of Obstetrics and GynecologyProfessor, Department of Obstetrics and Gynecology
Associate Dean, Continuing Medical EducationAssociate Dean, Continuing Medical Education
Case Study 1 – Neonatal Brain Injury, Case Study 1 – Neonatal Brain Injury, Neonatal Encephalopathy and Cerebral PalsyNeonatal Encephalopathy and Cerebral Palsy
A 27 year old primigravida was A 27 year old primigravida was admitted to the hospital in spontaneous admitted to the hospital in spontaneous labor at 38 weeks gestation. Her labor at 38 weeks gestation. Her pregnancy has been complicated by pregnancy has been complicated by mild gestational hypertension. She mild gestational hypertension. She also had a 2 day “viral” illness at 28 also had a 2 day “viral” illness at 28 weeks, with symptoms of low grade weeks, with symptoms of low grade fever and cough. fever and cough.
Case Study 1 (Cont’d)Case Study 1 (Cont’d)
Fetal growth has been normal. There have Fetal growth has been normal. There have been no other complications. The Group B been no other complications. The Group B Streptococcal culture was negative at 37 Streptococcal culture was negative at 37 weeks. Her labor progressed normally weeks. Her labor progressed normally through the first stage; an epidural was through the first stage; an epidural was inserted at 5 centimeters. Her second stage inserted at 5 centimeters. Her second stage of labor has become prolonged with arrest of of labor has become prolonged with arrest of fetal descent at +3 (of 5) station and a fetal fetal descent at +3 (of 5) station and a fetal position of right occiput anterior (ROA). position of right occiput anterior (ROA).
Case Study 1 (Cont’d)Case Study 1 (Cont’d)
Category II fetal heart tracing has Category II fetal heart tracing has developed, and meconium has become developed, and meconium has become evident. The obstetrician plans a low evident. The obstetrician plans a low forceps delivery.forceps delivery.
Case Study 2 – Shoulder Case Study 2 – Shoulder dystociadystocia
A 35 year old woman, gravida 3 para 2, A 35 year old woman, gravida 3 para 2, was admitted with spontaneous rupture was admitted with spontaneous rupture of the membranes 12 hours ago, at 40 of the membranes 12 hours ago, at 40 weeks gestation. She had two previous weeks gestation. She had two previous healthy infants, each by spontaneous healthy infants, each by spontaneous vaginal delivery, with birth weights of vaginal delivery, with birth weights of 8# each (about 3700 grams). Her 8# each (about 3700 grams). Her weight is 195 pounds, with a BMI of 30, weight is 195 pounds, with a BMI of 30, but her blood sugar screen was normal.but her blood sugar screen was normal.
Case Study 2 (Cont’d)Case Study 2 (Cont’d)
The estimated fetal weight on The estimated fetal weight on admission is 8 pounds (3700 grams). admission is 8 pounds (3700 grams). There is no evidence of There is no evidence of chorioamnionitis. On speculum exam, chorioamnionitis. On speculum exam, the cervix appears to be 2 centimeters the cervix appears to be 2 centimeters dilated. An unengaged vertex is dilated. An unengaged vertex is presenting.presenting.
An induction of labor is begun.An induction of labor is begun.
