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Benjamin P. Sachs, MB, BS, Discussant

JAMA. 2005;294:833-840.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

INTRODUCTION

DR DELBANCO: Mrs W is a married, self-employed, healthy woman living in a community several hours from Boston. She has private health insurance. At age 38, she was admitted to the hospital for elective delivery of her first child, but the admission ended tragically with fetal loss, hysterectomy, and a prolonged hospitalization.

The pregnancy, her first, was wanted and uneventful. When seen initially by her obstetrician, Mrs W’s blood pressure was 112/80 mm Hg. She showed no sign of labor at term. At 40 weeks of pregnancy, her blood pressure was 126/78 mm Hg, rising shortly thereafter to 144/85 mm Hg. She had trace proteinuria. Her creatinine level was 0.8 mg/dL (70.7 µmol/L), and her uric acid level was 6.3 mg/dL. At 41 weeks of gestation, her obstetrician, Dr F, decided to admit her for misoprostol induction. Dr F . . . [Full Text of this Article]

THE PATIENT AND HER HUSBAND: THEIR VIEWS

THE PRIMARY OBSTETRICIAN: HER VIEW

AT THE CROSSROADS: QUESTIONS FOR DR SACHS

Diagnosis and Risk Factors

The Outcome

What Went Wrong?

Patient Safety and Long Shifts

Improving Quality of Care

Responding to Mrs W’s Tragedy

Evaluating Systems Changes

QUESTIONS AND DISCUSSION

AUTHOR INFORMATION

Author Affiliation: Dr Sachs is Chief, Obstetrics and Gynecology, Beth Israel Deaconess Medical Center; Harold H. Rosenfield Professor of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School; and Professor in the Department of Society, Human Development and Health in the Faculty of Public Health, Harvard School of Public Health, Boston, Mass.

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