What caused chronic pain after repair of the vaginal wall?
A WOMAN IN HER THIRTIES underwent anterior and posterior repair of the vaginal wall, including repair of a cystocele and a rectocystocele. Postoperatively, the patient developed a chronic pain syndrome.
PATIENT’S CLAIM The ObGyn failed to properly perform the surgery, and damaged the pudendal nerve, which causes chronic pain. The ObGyn moved the levator ani muscle; the muscle shifted into the vaginal canal and damaged the pudendal nerve. Informed consent was not obtained.
PHYSICIAN’S DEFENSE The patient was fully informed of all the procedure’s risks. The injury could not have been from displacement of the levator ani muscle because the muscle cannot reach the vaginal canal. Pain is from scar formation that is entrapping a nerve.
VERDICT A New York defense verdict was returned.
DVT + estrogen-based contraception=stroke?
AFTER A DEEP VENOUS THROMBOSIS (DVT) in her leg at age 29, a woman was told by her family physician to avoid birth control that contained estrogen. She claimed she told her ObGyn of the history of DVT and the no-estrogen advice, but he prescribed and inserted a Nuva Ring, which contains ethinyl estradiol. A few months later, the woman was hospitalized with a severe headache, and suffered a stroke that affected her speech and cognitive functions.
PATIENT’S CLAIM The ObGyn was negligent in prescribing a contraceptive that contained estrogen, knowing the patient’s history of blood clot.
PHYSICIAN’S DEFENSE An injury caused the first clot; the Nuva Ring did not cause the second clot or stroke.
VERDICT A $523,000 Georgia verdict was returned.
New mother dies; was preeclampsia treated properly?
AT HER SEVENTH-MONTH VISIT to her ObGyn (Dr. A), a woman began to show signs of preeclampsia. Two weeks later, she went to the emergency department (ED) with chest pain, cough, and shortness of breath; she was found to have hypertension and tachycardia. She was examined by an emergency medicine physician (Dr. B), and discharged with a diagnosis of bronchitis and a finding of dyspnea.
At a scheduled prenatal visit 2 days later, she was hypertensive. Dr. A sent her to the ED, where a physician assistant noted signs of edema in her extremities. Attempts to draw arterial blood were unsuccessful, and crackles were heard in her lungs. She was diagnosed as having worsening preeclampsia with pulmonary edema, and admitted.
Dr. C, another ObGyn, decided to perform a cesarean delivery, but on the way to the OR, the patient became unresponsive. After delivery, she went into cardiopulmonary arrest and sustained anoxic brain injury. She died after life support was removed. An autopsy determined cause of death was anoxic encephalopathy due to respiratory arrest caused by preeclampsia.
ESTATE’S CLAIM Dr. A failed to provide proper prenatal care, and failed to recognize preeclampsia. Dr. B failed to recognize preeclampsia, failed to contact a specialist, and failed to immediately admit the patient for monitoring and treatment. Dr. C negligently administered a bolus of IV fluids when the patient showed signs of preeclampsia. He failed to administer medication to reduce fluid retention, and failed to timely admit the patient to the hospital.
PHYSICIANS’ DEFENSE All three physicians denied negligence.
VERDICT A $1.5 million Michigan settlement was reached.
Did resident use forceful traction with shoulder dystocia?
SHOULDER DYSTOCIA was encountered during vaginal delivery, and managed by a resident. The child suffered a brachial plexus injury.
PATIENT’S CLAIM The attending physician failed to 1) properly supervise the resident who was delivering the infant, and 2) prevent the use of traction after it was determined that shoulder dystocia was present.
PHYSICIANS’ DEFENSE The resident, under full supervision of the attending physician, utilized traction after the baby’s head was delivered and shoulder dystocia became evident—but traction was gentle. The maternal forces of labor caused the injury.
VERDICT A $950,000 Virginia settlement was reached.
Was patient informed that tubal ligation had not been performed?
PREGNANT WITH HER FOURTH CHILD despite birth control, a woman and her husband told the ObGyn that they did not want, nor could they afford, a fifth child. They requested bilateral tubal ligation during cesarean delivery. Two days before the scheduled birth, the mother went into labor. Her prenatal records could not be found, and the ObGyn’s office was closed. The ObGyn delivered the baby, but did not perform tubal ligation. She claimed she was never told that the tubal ligation had not been completed, even at the 6-week postpartum visit. She did not take precautions to prevent pregnancy, and later conceived a fifth child.
PATIENT’S CLAIM The ObGyn was negligent in not performing the tubal ligation and in not telling the patient until after the fifth child’s conception.