Page 68 - Avoiding Surgical Mishaps Part 1

SVMIC Avoiding Surgical Mishaps: Dissecting the Risks

CASE STUDY

A 37-year-old pregnant female with a history of multiple
miscarriages, cardiac issues, and gestational diabetes was
seen by her obstetrician.

At her first prenatal visit, her blood glucose was 148 with

+4 glucose in her urine. At 13 weeks gestation, her blood
glucose was 239, and she was referred to a maternal fetal
specialist, who started her on insulin and began diabetic

education. Throughout the pregnancy, she had three normal
ultrasounds and weekly fetal nonstress tests performed.
Midway through her pregnancy, her insurance coverage

lapsed, and she missed her next appointment.

Seven days before her due date, she presented to the

emergency department with increased blood pressure,
swelling, and heart palpitations. She was admitted by a

hospitalist and evaluated by a cardiologist who found no
acute etiology for her symptoms. Nursing notes indicated
fetal heart tones were detected at each shift, but no non-

stress test, fetal evaluation, or evaluation for pre-eclampsia
was done. Before she was discharged, the hospitalist called
the OB who requested she come to the office three days

later to assess for induction. When she arrived for induction,
(personal effects for impending hospitalization in hand) the
receptionist informed her that without verifiable insurance

coverage she would be required to make a substantial
payment before she could see the doctor. Unable to pay, she

left without being seen. No physician or clinical staff were
notified. Four days later, she appeared for
an office visit, but there were no fetal heart

tones. She subsequently delivered a stillborn
male infant weighing 10 pounds, 4 ounces.

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