OB/GYN Experts Focus on Early Warning Signs During Childbirth

Fetal Heart Rate Monitoring and Maternal Safety Discussed by Advisory Board

Napa, California—December 15, 2014—OB/GYN experts from around the nation addressed the prevention of maternal and infant injury or death in childbirth recently with leaders of The Doctors Company, the nation’s largest physician-owned medical malpractice insurer.

Problems with monitoring fetal heart rate and missing early warning signs of maternal collapse are serious potential malpractice risks and threats to patient safety, according to two physicians who were invited by The Doctors Company to present at the fifth annual meeting of its OB Advisory Board. This select group of practitioners meets annually to generate insights that can help improve safety for OB professionals.

“Poor communication of abnormal fetal heart rate monitoring is a serious malpractice risk,” said Michael Nageotte, MD, a member of the Perinatal Quality Foundation Board, past president of the Society of Maternal Fetal Medicine, and medical director, Obstetrix Medical Group of Southern California. “Credentialing, in which practitioners demonstrate both knowledge and judgment of fetal heart rate monitoring using definitions established by national consensus, may lessen this risk.”

The Perinatal Quality Foundation, Dr. Nageotte noted, has developed a credentialing program to address how practitioners would respond in different clinical scenarios when there is an issue with fetal monitoring. It provides separate credentialing tests for OB nurses and physicians and includes questions designed to address the dynamics of labor and delivery.

Many early warning signs of impending maternal life-threatening illnesses go unrecognized because they are so rare, according to Jill Mhyre, MD, of the Council on Patient Safety in Women’s Health Care and associate professor of anesthesiology and director of obstetric anesthesia at the University of Arkansas.

According to the Council on Patient Safety in Women’s Health Care, every birthing center in the United States should have tools to identify maternity patients who require urgent bedside evaluation by a physician, including previously tested and verified examples of OB warning criteria that identify critical vital signs and symptoms. These tools should also include differential diagnoses and potential next steps.

“Centers need to start working on their response systems, defining steps to take when a physician is not present,” Dr. Mhyre said. As an example, she outlined an early warning system initiated by Stony Brook (NY) University Medical Center that involves scoring patients’ vital signs and other symptoms, leading to a staged response.

Other OB/GYN patient safety issues discussed at the meeting were:

  • Water birth, by Larry Veltman, MD, FACOG, perinatal safety and risk management consultant and advisory board member.
  • Morcellation and cancer link, by Marcus Tower, MD, FACOG, Hillcrest Hospital, Cleveland Clinic Foundation, and advisory board member.
  • The use of nitrous oxide for labor analgesia, by Pamela Willis, BSN, JD, RN, patient safety risk manager with The Doctors Company.

More information on reducing risks and promoting patient safety can be found in the Guide to Patient Safety and Reducing Liability in Obstetrics & Gynecology, published by The Doctors Company.

About The Doctors Company
Founded and led by physicians, The Doctors Company (www.thedoctors.com) is relentlessly committed to advancing, protecting, and rewarding the practice of good medicine. The Doctors Company is the nation’s largest physician-owned medical malpractice insurer, with 75,000 members and $4.3 billion in assets, and is rated A by A.M. Best Company and Fitch Ratings.

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