FILLING FORMS
Maintain a form for further follow-up in your clinic. One never knows when the information is required.
The routine information required in these forms is:
- Name
- Age
- Address
- Telephone Number
- Referred by
- PNDT Act Form ‘F’ as required by Government of India law
- Undertaking by patient and doctor for obstetric ultrasound with Form ‘F’ and Form ‘G’
- For genetic defects for interventional procedures, the clinic has to be specially registered and licensed by Government under the PNDT Act as a genetic Lab.
RELEVANT HISTORY
Always spend few minutes with your patient to take the details of the history. It gives confidence to the patient and you get your perspective of what all to expect.
The history to be taken routinely is:
- Any symptoms in this pregnancy
- Any ultrasound done so far in this pregnancy. Check the records carefully
- Last menstrual period and regularity of menstrual cycles.
- Any tests done and their reports
- Referring doctors requisition slip (This is now a legal requirement with Form ‘F’).
Any good resolution scanner is a requisite for interventional procedures and should have all the probes (transabdominal and transvaginal) all standard accessories, biopsy guides for both probes, recording and documenting facility and different types of needles, etc.
- Machine with transabdominal and transvaginal probes
- Minor operation theatre
- Biopsy guides for transabdominal and transvaginal probes.
- Biopsy needles of all sizes and lumen for abdominal and vaginal routes
- Standard accessories
- Standard equipment for minor OT procedure
- Consent form.
PATIENT PREPARATIONS
Patient is prepared for as any other minor operative procedures.
- Admission charts and proper consent
- Preoperative antibiotic and Tetvac injection
- Preoperative part preparation, bowel and bladder evacuation
- Supine/lithotomy position
- Sterilized probe (Dipping in Cidex solution)
- Aseptic measures
- Analgesia/anesthesia.
COUNSELING AND LEGAL ASPECTS
- Proper genetic registered center (PNDT Act)
- Genetic screening (Flowchart 1.1A)
- Genetic counseling for chromosomal defects
- Counseling for procedure and side effects (Flowchart 1.1B).
- Legal consent
- Counseling for acceptable procedure-related risks and abortions (Pre and post-test counceling)
Flowchart 1.1A: Genetic screening algorithm.FTS: first trimester screening; eFTS: extended FTS; NIPS: noninvasive prenatal screening; CF-DNA: cell free DNA; ONTD: open neural tube defects; USG: ultrasonography; AFP: alpha-fetoprotein; CVS: chorion villus sampling.
Note: A plaintiff must demonstrate that the physician breached the standard care and his action/inaction caused injury, since the standard care is so rapidly changing the physician must be alert to new developments and must inform these to the patient.
DOCUMENTATION AND REPORTING
- Proper hard copy/soft copy documentation
- Detailed step-wise procedure reporting
- Report complications
- Clear follow-up of instructions.
ANALGESIA AND ANESTHESIA
Usually these procedures are quick and relatively painless and require only reassurance, mild analgesia and local anesthesia.
- Local anesthesia
- Analgesic injections
- Short general anesthesia with propofol, pentothal or ketamine
- All standard resuscitation equipment
- Trained anesthetist (Fig. 1.6).