Undisclosed venue (Calif)
A 31-year-old woman, pregnant for the third time, was admitted on her due date to the hospital for delivery. She began to vomit blood during labor and, after she delivered a healthy baby, continued to bleed excessively from the uterus and the epidural injection site. The anesthesiologist and obstetrician diagnosed amniotic fluid embolism with disseminated intravascular coagulation (DIC). STAT testing confirmed the diagnosis, and the anesthesiologist ordered packed red blood cells and fresh frozen plasma. The woman was intubated, placed on a ventilator, and transferred to the ICU, where the internist on call was a rheumatologist unfamiliar with amniotic fluid embolism. Although the rheumatologist ordered transfusions of blood and clotting factors, the orders were carried out on a delayed basis or not at all.
During the next 4 hours, the woman received 4 of 6 ordered units of packaged red blood cells; 2 of 10 to 14 ordered units of fresh frozen plasma; and none of the 10 units of cryoprecipitate. The results of a STAT fibrogen were extremely low, requiring an emergency cryoprecipitate treatment, but this report did not reach the ICU for 2.5 hours.
After the woman’s blood pressure dropped, arterial blood gas results showed a pH of 7.15, indicating metabolic acidosis. An hour later the woman’s hematocrit was noted to have dropped from 36 at an earlier measurement to 16. The woman’s husband (a nurse) noticed abnormal beats on her cardiogram strip and alerted the ICU nurse.
The woman then had cardiac arrest and was in asystole for 10 to 11 minutes. She sustained kidney damage, which required dialysis for several months, and liver damage, both of which she recovered from fully. She also had hypoxic brain damage and requires constant custodial care. She can no longer care for her children or perform other ordinary household tasks.
The family claimed negligence by the hospital in assigning the woman’s care to a rheumatologist with no experience in managing amniotic fluid emboli and DIC. They also claimed that the failure to administer sufficient blood cells and fresh frozen plasma, not to mention cryoprecipitate, led to the cardiac arrest and brain damage. The hospital contended it had acted appropriately and observed that DIC is unpredictable regardless of the treatment given.
- The parties settled for $1.7 million.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.