Article Figures & Data
Tables
Category I Category II Category III Category IV For the following patient problems, the family physician must share responsibility or refer to a board-certified obstetrician-gynecologist (OB/GYN) or perinatal specialist. The family physician may participate in patient care under the direction of the OB/GYN or perinatologist. For the following patient problems, the family physician must obtain appropriate tests, or obtain consultation from a board certified obstetrician gynecologist or appropriate perinatal specialist. Patient care responsibilities may be shared if mutually agreeable to the family physician and other specialist. For the following patient problems, the family physician does not need to obtain consultation if his/her training and privileges allow for managing these problems. Complete documentation and appropriate management of these problems must be apparent in the record. The newborn factors listed below require immediate assessment by the physician and the initiation of treatment and referral if necessary. Initial prenatal factors Initial prenatal factors Initial prenatal factors Major anomalies Multiple pregnancy Age >40 or <16 Habitual smoking Respiratory distress Insulin-dependent diabetes Drug dependency Single parent, questionable social support Five minute APGAR <6 Chronic hypertension High-risk family (lack of family/social support)* Height under 5 feet Maternal pelvic infection Renal Failure Uterine or cervical malformation or incompetency Obesity (normal glucose screening) Small for gestational age Heart disease (class II or greater) Contracted pelvis Underweight Macrosomia Hyperthyroidism Previous cesarean section Primigravida Infant of a diabetic mother Rh isoimmunization Multiple spontaneous abortions (>3) Second pregnancy in 12 months Hypoglycemia, hypocalcemia Chronic active hepatitis Grand multiparity (>8) History of congenital abnormalities Seizures Convulsive disorder History of gestational diabetes Family history of diabetes Prematurity, postmaturity, dysmaturity Isoimmune thrombocytopenia Previous fetal or neonatal demise† Anemia (mild or moderate) Meconium aspiration Subsequent prenatal and intrapartum factors Hypothyroidism Medical problems (eg, asthma, acid/peptic disease, maternal infections) Birth trauma Vaginal bleeding (2nd or 3rd trimester) Heart disease (class I) Subsequent prenatal and intrapartum factors Preeclampsia (Toxemia) Moderate or Severe Severe anemia (unresponsive to Fe) First trimester bleeding Fetal malformation, by AFP screening, ultrasound or amniocentesis Pelvic mass of neoplasia Urinary tract infection Abnormal presentation: breech, face, brow, transverse Subsequent prenatal and intrapartum factors Pelvic infection Intrauterine growth retardation Gestational diabetes Prenatal weight gain >40 lbs. or <15 lbs. Hydramnios Preeclampsia (toxemia) mild Prolonged latent phase or labor Pregnancy >43 weeks or <37 weeks Pregnancy at 41 weeks, obtain appropriate fetal/placental tests Meconium staining Abnormal fetal/placental tests Active genital herpes Pitocin augmentation of labor Persistent severe variable or late decelerations Positive high or low AFP screen Outlet forceps or vacuum extraction Macrosomia Estimated fetal weight >10 lbs or <6 lbs Repair of third or fourth degree laceration Cord prolapse Abnormal non-stress test Newborn resuscitation Mid forceps delivery Arrest of normal labor curve Manual removal of placenta Persistent moderate variable decelerations/poor baseline variability Ruptured membrane beyond 24 hours Second stage beyond 2 hours Induction of labor * Consultation may be with appropriate social service agency
† Consultation may be with perinatal genetic counselor.
Year Physicians Participants (N) Physicians Submitting Delivery Records Deliveries Recorded (N) Rural* Physicians Urban Physicians Solo or Two Physician Practices N % N % N % N % 1989 74 66 89 2557 35 47 39 53 41 55 1990 92 82 89 3347 48 52 44 48 56 61 1991 97 93 96 3672 50 52 47 48 55 57 1992 117 110 94 3995 54 46 63 54 67 57 1993 119 111 93 4016 54 45 65 55 69 58 1994 118 109 92 4187 57 48 61 52 62 53 1995 114 109 96 3616 55 48 59 52 56 49 1996 112 99 88 2816 57 51 55 49 55 49 1997 98 81 83 2373 50 51 48 49 48 49 1998 82 74 90 2252 34 42 48 58 42 51 AVG 102 93 91 3283 49 48 53 52 55 54 * Population density of less than 250 persons per square mile and not wholly containing an incorporated area of greater than 50,000 persons. Data source: Office of Statewide Planning and Development.
Loss Date Nature of Claim Settlement 5/22/1992 Negligent prenatal care $29,999 Fetal demise 2/10/1993 Negligent prenatal care $950,000 Uterine rupture delayed cesarean section, severe brain damage 1/17/1994 Negligent prenatal care $29,999 Shoulder dystocia resulting in brachial plexus injury 7/21/1994 Negligent prenatal care $29,999 Shoulder dystocia resulting in brachial plexus injury
Jump to section
Related Articles
Cited By...
- No citing articles found.