Medicolegal Issues

Was the pregnancy ectopic or intrauterine?

Notable judgements and settlements


 

Was the pregnancy ectopic or intrauterine? A 40-year-old woman underwent ultrasonography (US) during an office visit with her ObGyn. Results indicated that there was no gestational sac in the uterus. Following repeat US at a radiology facility, the radiologist reported that he saw no evidence of pregnancy in the uterus but did see a complex structure outside the uterus. He recommended follow-up US to further investigate the possibility of an ectopic pregnancy. After reading the radiologist’s report, the ObGyn concluded that it was highly likely that the woman had an ectopic pregnancy. He sent her to a hospital’s emergency department (ED) for an injection of methotrexate to manage the ectopic pregnancy.

Two days later, the patient returned to the ED with abdominal pain and vaginal spotting. US results showed an intrauterine pregnancy. However, based on the high risk of fetal deformity or death caused by methotrexate, the patient agreed to undergo surgical removal of fetal remains.

PARENT'S CLAIM: The patient and her husband sued the radiologist, alleging that his misreading of the subsequent US fell below the standard of care. If he had not misread the US, the ObGyn would not have ordered termination of an ectopic pregnancy with a teratogenic medication.

PHYSICIAN'S DEFENSE: The case was settled during trial.

VERDICT: An undisclosed Arizona settlement was reached with the radiologist.

Have you read this Editorial by Dr. Barbieri?
Stop using the hCG discriminatory zone of 1,500 to 2,000 mIU/mL to guide intervention during early pregnancy. (Editorial; January 2015)

Increasing pain after ovarian cystectomy: $1.5M A woman in her 40s underwent ovarian cystectomy performed by her gynecologist. After surgery, the patient reported increasingly intense abdominal pain to the gynecologist. After 10 days, laboratory testing showed an increase in the patient’s white blood cell count. During exploratory surgery, a perforation was found in her sigmoid colon, and a colostomy was performed.

PATIENT'S CLAIM: The gynecologist was negligent in injuring the colon and then not intraoperatively identifying and repairing the damage. Postoperatively, the gynecologist failed to address the injury in a timely manner.

PHYSICIAN'S DEFENSE: A colon injury is a known complication of the procedure. Such injuries are often not identified until days after the surgery.

VERDICT: A $1.52 million New York verdict was returned.

Bladder injury causes multiple operations A woman in her 30s underwent a hysterectomy performed by her ObGyn. During the procedure, the ObGyn perforated the patient’s bladder. The ObGyn attempted to repair the injury, but then called in a urologist to complete the procedure. The urologist had to reduce the size of the bladder in order to complete the repair. The patient underwent additional operations to treat a postsurgical infection and adhesions. During an operation to treat infection, a surgeon found that the ureter had been reimplanted.

PATIENT'S CLAIM: During the first repair procedure, the urologist was negligent in not inspecting adjacent organs for damage before closing. Infection developed because the repair was improperly performed.

PHYSICIAN'S DEFENSE: The urologist denied negligence. Infection is a known complication of an intraoperative bladder injury.

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