ABOG Risk Management & Mitigation 3 — Questions and Answers
Question 1: A hospitalized patient with preeclampsia with severe features does not speak English. Which risk management measure is most critical before obtaining informed consent for induction of labor?
- Ask the patient's family member to interpret medical information
- Use a qualified medical interpreter (in-person or video) to ensure informed consent (Correct answer)
- Proceed with induction since delay is unsafe
- Document 'language barrier' and obtain verbal consent only
Correct answer: Use a qualified medical interpreter (in-person or video) to ensure informed consent
Qualified medical interpreters must be used—not family members—to ensure accurate communication of risks and to obtain legally valid informed consent.
Question 2: Which approach best prevents venous thromboembolism (VTE) after cesarean delivery in a patient with no other risk factors?
- Bedrest for 48 hours postoperatively
- Early ambulation and pneumatic compression devices intraoperatively and postoperatively (Correct answer)
- Prophylactic anticoagulation started immediately after delivery
- Compression stockings alone for 6 weeks
Correct answer: Early ambulation and pneumatic compression devices intraoperatively and postoperatively
Early ambulation combined with sequential compression devices (SCDs) is the standard VTE prophylaxis for average-risk patients undergoing cesarean delivery.
Question 3: A resident performs a vaginal delivery without attendingphysician supervision, resulting in a 4th-degree laceration that is misrepaired. Which root cause most represents a systems failure?
- Resident incompetence alone
- Absence of a supervision policy and failure of attending availability systems (Correct answer)
- Patient anatomic risk factors
- Inadequate patient cooperation during delivery
Correct answer: Absence of a supervision policy and failure of attending availability systems
Systems failures—such as lack of supervision policies and attending availability failures—are root causes amenable to process improvement in patient safety frameworks.
Question 4: A physician discovers a medication error (incorrect oxytocin dose) after the patient has been discharged without apparent harm. What is the most appropriate next step from a risk management perspective?
- Take no action because the patient was not harmed
- Complete an incident report, disclose the error to the patient, and conduct a root cause analysis (Correct answer)
- Only notify the attending physician verbally
- Delete the erroneous order from the electronic record
Correct answer: Complete an incident report, disclose the error to the patient, and conduct a root cause analysis
Even near-miss medication errors require incident reporting, patient disclosure, and root cause analysis to prevent future harm and fulfill ethical and legal obligations.
Question 5: Which action is most important when managing a patient with abnormal uterine bleeding (AUB) in a clinic setting to mitigate risk of missed endometrial carcinoma?
- Treat empirically with hormones for 6 months before evaluation
- Perform endometrial sampling in women ≥45 years or with risk factors regardless of bleeding pattern (Correct answer)
- Reassure all premenopausal patients that AUB is benign
- Order a pelvic ultrasound only if pelvic exam is abnormal
Correct answer: Perform endometrial sampling in women ≥45 years or with risk factors regardless of bleeding pattern
ACOG guidelines recommend endometrial biopsy in women ≥45 or younger women with risk factors (obesity, chronic anovulation) to exclude endometrial carcinoma.
Question 6: During a laparoscopic salpingectomy, the surgeon notes unexpected bleeding but cannot identify the source clearly. What risk management principle should guide the next decision?
- Continue laparoscopy indefinitely until the source is found
- Convert to laparotomy when adequate visualization cannot be achieved to ensure patient safety (Correct answer)
- Coagulate broadly in the area of bleeding without visualization
- Close the case and plan reoperation the next day
Correct answer: Convert to laparotomy when adequate visualization cannot be achieved to ensure patient safety
Conversion to laparotomy when visualization is inadequate reflects sound surgical judgment and is a patient safety imperative, not a sign of failure.
Question 7: A patient reports her previous physician told her she had an allergy to penicillin. She requires prophylactic antibiotics for cesarean. What is the most evidence-based risk management approach?
- Withhold all antibiotics to avoid anaphylaxis
- Use cefazolin for most patients after risk stratification, as true penicillin allergy cross-reactivity with cephalosporins is <1% (Correct answer)
- Use vancomycin as the sole prophylactic agent in all reported penicillin allergy cases
- Obtain allergy skin testing before any surgical antibiotic prophylaxis
Correct answer: Use cefazolin for most patients after risk stratification, as true penicillin allergy cross-reactivity with cephalosporins is <1%
Current evidence and ACOG guidance support cefazolin use in patients with low-risk penicillin allergy histories, given the very low cross-reactivity rate.
ABOG Risk Management & Mitigation 3
A hospitalized patient with preeclampsia with severe features does not speak English.
Which risk management measure is most critical before obtaining informed consent for induction of labor?