Page 34 - OB Risks - Delivering the Goods (Part One)

SVMIC Obstetrics Risks: Delivering the Goods

C A S E S T U DY

A 20-year-old gravida 2, para 1, presented for her first

obstetrics appointment at 34 weeks gestation. She had

a history of a previous cesarean section due to failure
to progress. During the prenatal visit, the obstetrician
discussed the risks, benefits, and alternatives associated

with the trial of labor after a previous C-section, as well as

those associated with having another C-section without
a trial of labor. The patient elected to have a repeat
C-section. This was all well-documented in the patient’s

record.

The patient arrived at the hospital in labor at 40 weeks and
was diagnosed with oligohydramnios. Her obstetrician

was not available upon admission, so a resident physician
provided care during labor. The patient’s prenatal record,

with the information about the decision to have a C-section
rather than go through a trial of labor, was not available in

the hospital. The resident was made aware of the patient’s
previous C-section, so he reviewed the risks and benefits

of the trial of labor and she agreed to proceed with a trial
of labor. There was no indication whether the physician

presented the patient with the option to have a C-section
rather than a trial of labor.

Labor progressed slowly and the patient became
uncooperative, restless, and complained of excessive

pain. The hospital staff was unable to maintain fetal heart

tracings on the monitor, so a stat ultrasound was done
revealing a fetal heart rate in the seventies. At this point,
the patient’s attending physician was notified, and a

stat C-section was performed. The C-section revealed a

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