Page 22 - OB Risks - Delivering the Goods (Part Two)

SVMIC Obstetrics Risks: Delivering the Goods

complications may include puerperal infection, complications
43
related to emergency hysterectomy, and other complications
44
related to the surgery itself. Consider the following case:

C A S E S T U DY

A 22-year-old gravida 2, para 1, who had a previous cesarean

section on October 19 because of oligohydramnios and
th
eventual fetal distress that resulted in a viable infant,

presented to her OB the following year on March 3 for
rd
her first prenatal visit. The pregnancy continued with no

serious problems, and pelvic ultrasounds confirmed an
estimated date of confinement of October 4 . On August
th
25 , she had an appointment with her OB who made a
th
note of “vaginal birth after cesarean section counseling”.

There was no written description of the discussion beyond
that short note.

The patient’s adherence to prenatal visits was sporadic in

the latter part of pregnancy with a couple of no-shows.
She presented to labor and delivery on September 27
th
in the afternoon and was evaluated for decreased fetal

movement along with the abdominal pain. She was not

seen by a physician at that time. The nurse discharged the
patient after evaluation, and the patient again returned
early the following morning at 2:28 am with similar

complaints of contractions and decreased movement. All

blood pressures were normal at that time. The cervix was
noted to be dilated at 1cm with a 50 percent effacement at
a -3 station. Membranes were intact and, again, the patient

43 https://medictests.com/units/post-partum-complications
44 https://journals.lww.com/greenjournal/pages/articleviewer.
aspx?year=2010&issue=03000&article=00023&type=Fulltext

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