1.11 Obstetric Consent

Question 1

Define Consent

Answer 1

1. Permission for Rx, Ix or physical contact with patient
2. Valid: voluntarily given by approp informed person
3. Capacity
   ability understand consequences
   weight up Risk -v- Benefit
   Retain info relevant to decision

Question 2

Obstetric problems

Answer 2

Controversy over judgement and capacity labouring woman

1. Physical and psych stress
2. Pain
3. Fatigue
4. Anxiety
5. Drugs
   Entonox / opiates

Question 3

Obstetric problems

Answer 3

May be reasons for procedure patients doesn’t understand
PET / Obesity

Some cases procedure with severe complications in young fit person

Question 4

Consent someone for an epidural

Answer 4

1. Introduction to woman and partner
2. Concise and relevant anaes and obs Hx
   ensure no c/i
3. Check bloods
   coag / plts
4. Explain benefits
5. Explain risks

Question 5

Benefits

Answer 5

1. Superior analgesia
2. Rest
3. Provision of syntocin
4. allows top up for surgical anaesthesia
5. Lowers BP in PET

Question 6

Risks

Answer 6

Controversy around rarer risks - decide individual basis

1. Inadequate or unilateral blok
   - failure and postential resite
2. Bruising at site injection

3. Shivering
itching 
urinary retention 
Motor block
1/10 chance each

4. Headache
   1 in 100-150
5. BP
   easily Rx fluid and drug
6. Temporary nerve damage
   1 in 3-7000
7. IV injection
   Total spinal
8. Persistent or Perm Nerve damage
   1 in 25000-160000
9. Meningitis
   1 in 100,000 -1,000,000
10. Paralysis
    <1 in 100,000