Demographic changes can account for some of the increase in complications. Many women are delaying parenthood until their late 30s and early 40s and experiencing issues that go along with advanced maternal age. The steady rise in obesity in the U.S. means that more expectant mothers are overweight, so their health may be compromised even before their pregnancies. Chronic conditions, such as diabetes or liver disease, can also put women at higher risk for complications throughout pregnancy. However, the most common cause of death after childbirth, severe bleeding, or hemorrhage, can affect even healthy women with no history of problems during pregnancy.

Danielle Dargatz, a 25-year-old Milwaukee woman, had experienced a healthy pregnancy and wasn’t considered high-risk for complications when she delivered her daughter in 2012. Unfortunately, following the birth she began hemorrhaging and her doctor was unable to stop the bleeding with medication and other traditional measures. A surgical team was called in to perform an emergency hysterectomy. Ms. Dargatz’s story has a happy ending, but some women and their children aren’t as lucky.

While most complications in pregnancy and childbirth are not life-threatening, a certain percentage will result in death. In the U.S. annually, severe birth injury and labor and delivery complications affect over 50,000 women per year. $17.4 billion in annual U.S. hospital costs comes from obstetrics-related complications, according to the federal Agency for Healthcare Research and Quality. Premier, Inc. They estimate that over a quarter of a hospital’s total of medical malpractice claims is attributed to birth injury lawsuits and other obstetrical complications.

While the healthcare industry works toward creating a safer environment for mothers giving birth and their newborn babies, expectant parents should choose their obstetricians carefully. Likewise, if given the choice, expectant parents should also select a hospital that providers a high degree of care for both routine and non-routine deliveries. Choosing the best possible obstetrician and hospital will reduce the risk of birth related complications. In the event a complication does arise, top quality physicians and hospitals staff will also decrease risk that a labor and delivery complication will result in permanent harm to mom or baby.

Sources Used:

The Wall Street Journal, Steep Rise of Complications in Childbirth Spurs Action, 12-10-12.

Lead by lead researcher, Dr. Clara N. Lee of the University of North Carolina School of Medicine, Chapel Hill, the retrospective study evaluated the decision making process of early stage breast cancer patients regarding surgical treatment. Surveys were mailed out to adult women with a history of early-stage invasive breast cancer treated at one of four academic medical centers: The Dana-Farber Cancer Institute, Boston; Massachusetts General Hospital, Boston; University of California, San Francisco; and University of North Carolina, Chapel Hill. Based on answers to basic questions about their disease and treatment options, patients answered only half their questions right (52%), demonstrating these patients had a large knowledge gap regarding their disease and treatment choices.

Because study data was collected an average of 2 ½ years after the patient’s surgical procedure, researchers recognized that some patients are likely to forget some information over time. However, the information that was forgotten was simply too basic, according to researchers, to be simply forgotten. For example, only half of breast cancer survivors from the study knew the survival rate was the same for breast-conservation therapy and mastectomy. Likewise, breast cancer survivors who underwent a partial mastectomy routinely did not know the local recurrence rates (compared to women who had a mastectomy).

According to Dr. Lee, “patients and providers need to have transparent conversations about treatment options, risks and goals in order to make fully informed decisions.” Dr. Lee’s remarks are fully supported by the American Medical Association stated beliefs on informed consent. According to the AMA, “[i]nformed consent is more than just getting a patient to sign a consent form.” The AMA acknowledges the communication process requires the physician to provide the patient: their diagnosis (if known); nature and purpose of the proposed treatment or procedure; the risks and benefits of the treatment or procedure; alternative treatment, along with the risks and benefits of the alternative treatment; and the risks of benefits of not receiving treatment. In addition, doctors must give the patient the opportunity to ask questions about any of this information in order to better understand of their options. As the AMA recognizes, informed consent is more than just a legal obligation necessary to defend against medical malpractice claims. It is an ethical obligation. Unfortunately, as this most recent study illustrates, some doctors often fail to honor either obligation.

With virtually all same-day surgery procedures, the most significant risk is from the anesthesia. Although there are many forms of anesthesia, general anesthesia poses the greatest risk of serious injury or wrongful death. Indeed, most medical malpractice lawsuits stemming from anesthesia error involve general anesthesia. Common general anesthesia complications are from aspiration, changes in vital signs, and adverse reactions to anesthetic.

Regarding adverse anesthetic reactions, the most significant and potentially fatal condition that can develop is called malignant hyperthermia (or MH). This occurs when a patient’s body temperature rapidly increases and causes muscle rigidity. With proper management, many patients will experience a full recovery. Without proper management, patients can and do die from MH.

An expert panel from Penn State College of Medicine recommends that all ASCs develop policies for managing malignant hyperthermia. One key guideline recommended by the panel is that ASCs develop plans for immediately transferring patients who experience MH to a nearby hospital for more advanced care. According to the report, MH patients must be immediately transferred to a hospital that is equipped to provide critical care crisis management. After all, most ASCs do not have the ability to manage potentially life threatening anesthesia complications like MH. The panel also recommends that ASCs implement guidelines on giving immediate muscle relaxant medication to MH patients before transfer. After all, for every 30 minutes of delayed muscle relaxant medication to patient with MH, the risk of serious complication doubles.

Although relatively rare, anesthesia complication can be very serious if not fatal. Consequently, any patient with a history of anesthesia complications or who is otherwise at increased risk of anesthesia complication should strongly consider having any surgery involving anesthesia at a hospital rather than an ASC. Indeed, any patient considering surgery that involves general anesthesia should do their homework before blindly agreeing to have their surgery performed at an ASC. Although many ASC have excellent medical staff, few can handle major anesthesia complications as well as competent hospital.

Sources Used:

Medical News Today Website, Guidelines For Managing Rare Anesthesia Complication At Ambulatory Surgical Center, January 3, 2012.

Wikipedia, Outpatient Surgery, January 3, 2012.

WebMd, Anesthesia Risks And Complications, January 3, 2012.