Risk Management & Mitigation Flashcards

A patient with a history of two prior cesareans is found to have placenta previa on second-trimester ultrasound. What is the most important risk mitigation step for delivery planning?

Answer: Schedule delivery at a facility with interventional radiology, blood banking, and neonatal ICU capabilities, and counsel about placenta accreta spectrum risk

Patients with prior uterine surgery and placenta previa have elevated placenta accreta spectrum risk and should deliver at centers with multidisciplinary hemorrhage management capabilities.

Which handoff communication tool is most widely recommended to reduce errors during transitions of care on labor and delivery?

Answer: Structured SBAR (Situation, Background, Assessment, Recommendation) handoff with read-back confirmation

SBAR structured handoff with read-back is endorsed by The Joint Commission and ACOG to standardize communication and reduce errors at transitions of care.

A gynecologic oncology patient on chemotherapy presents with fever of 38.5°C and an ANC of 400 cells/µL. What is the most critical immediate intervention?

Answer: Hospital admission, blood cultures, and broad-spectrum IV antibiotics within 1 hour (febrile neutropenia protocol)

Febrile neutropenia is a medical emergency requiring immediate blood cultures and empiric broad-spectrum IV antibiotics within 1 hour to reduce mortality.

After performing an unintended cystotomy during laparoscopic hysterectomy that was immediately repaired, what is the surgeon's most important risk management obligation?

Answer: Disclose the intraoperative complication to the patient, document thoroughly, and arrange urology follow-up

Full disclosure of intraoperative complications, even repaired ones, is ethically mandatory and reduces medicolegal risk; accurate operative documentation is essential.

Which intervention most reduces the risk of maternal mortality from obstetric hemorrhage at a community hospital?

Answer: Implementing a standardized massive transfusion protocol with a predefined ratio of packed RBCs, FFP, and platelets

Massive transfusion protocols using balanced ratios (typically 1:1:1 of pRBC:FFP:platelets) reduce coagulopathy and mortality in obstetric hemorrhage.

A patient on magnesium sulfate for eclampsia prophylaxis develops respiratory depression (rate 8/min) and loss of deep tendon reflexes. What is the immediate intervention?

Answer: Discontinue magnesium infusion and administer calcium gluconate 1 g IV

Magnesium toxicity causing respiratory depression and loss of DTRs requires immediate cessation of magnesium and administration of calcium gluconate as the antidote.

Which strategy is most effective at the institutional level for reducing the incidence of primary cesarean delivery and its associated long-term risks?

Answer: Implementing ACOG/SMFM safe prevention guidelines including standardized labor management protocols and liberal use of operative vaginal delivery

The Obstetric Care Consensus on safe prevention of primary cesarean recommends standardized labor management, allowing adequate labor progress time, and encouraging operative vaginal delivery to reduce cesarean rates.