What are my responsibilities when handing over care of a patient who experienced shoulder dystocia with an arterial cord gas pH of 6.9 at the end of my shift?

Responsibilities After a Shoulder Dystocia with Uncertain Outcome

You must be part of the team that speaks directly to the patient and answer any questions, even though your shift is ending. This is your professional responsibility when involved in a serious obstetric emergency with potential adverse outcomes.

Rationale for Direct Communication

When a shoulder dystocia occurs with an arterial cord gas pH of 6.9 (indicating significant fetal acidosis), this represents a serious obstetric emergency with potential for:

• Neonatal hypoxic-ischemic brain injury
• Brachial plexus injury
• Other complications requiring immediate attention

Professional Obligations

The principles of medical professionalism require you to:

1. Maintain continuity of care - As the provider involved in the emergency, you have unique insights into what occurred that cannot be fully conveyed through handoff
2. Demonstrate honesty and integrity - Direct communication shows accountability for care provided
3. Prioritize patient welfare - Your presence demonstrates commitment to the patient's well-being above your own convenience

Communication Approach

When speaking with the patient:

• Be honest about what occurred during the delivery
• Explain the emergency procedures that were performed
• Discuss the current status of the baby and what the cord gas pH of 6.9 means
• Answer questions directly without being defensive
• Express appropriate concern without admitting fault

Team-Based Communication

While you must be present, this should be a team approach:

• Include the incoming provider in the conversation for continuity
• Involve pediatrics to discuss the baby's current condition and prognosis
• Consider including nursing leadership if appropriate

Documentation Considerations

Before leaving:

• Complete thorough documentation of the shoulder dystocia event
• Include all maneuvers attempted, their timing, and the total head-to-body delivery interval
• Document the cord gas results and initial neonatal assessment

Why Other Options Are Inappropriate

1. Simply telling incoming caregivers to speak with the patient: This fails to meet professional standards for continuity of care and accountability 1. The American Academy of Pediatrics emphasizes that physicians have a responsibility to communicate directly with patients, especially in critical situations.

2. Having only the pediatrician speak with the patient: While the pediatrician must be involved, you have specific knowledge about the obstetric emergency that is crucial for the patient's understanding.

3. Suggesting the patient not see the baby: This violates principles of patient-centered care and could cause additional psychological trauma to the parents.

Potential Complications to Address

Be prepared to discuss:

• Potential for hypoxic-ischemic encephalopathy
• Risk of brachial plexus injury (occurs in 4-40% of shoulder dystocia cases) 2
• Possible clavicular fractures (occur in approximately 10% of cases) 2
• Maternal complications such as postpartum hemorrhage or perineal trauma

Conclusion

The arterial cord gas pH of 6.9 indicates significant fetal acidosis that could lead to serious neonatal complications. Despite your shift ending, your professional responsibility requires you to participate in direct communication with the patient about this serious event before you leave.