a nonsurgical cause?
A 34-YEAR-OLD WOMAN GAVE BIRTH to a healthy baby by cesarean delivery. Several weeks later, the mother reported abdominal pain, distention, and nausea. Her ObGyn suspected it was related to a somatic disorder.
Two months after delivery, the mother came to the emergency department with increasingly severe symptoms. One month later, at another hospital, physicians diagnosed a bowel obstruction. During emergency surgery, a lap sponge was found within the lumen of the patient’s small intestine.
PATIENT’S CLAIM The ObGyn left the lap sponge in her abdomen during cesarean delivery.
PHYSICIAN’S DEFENSE The sponge count from the cesarean delivery was correct. The ObGyn suggested that the patient had swallowed the sponge, because it was found within the lumen of the intestine, not in free space. The surgeon who removed the sponge agreed with the ObGyn, and recommended a psychiatric consult.
VERDICT A Louisiana defense verdict was returned.
Did vacuum extraction cause developmental delays?
SUCCESSFUL DELIVERY was performed using vacuum extraction. Later, mild balance and coordination issues, cognitive deficits, and speech delay were diagnosed in the child.
PATIENT’S CLAIM Use of the vacuum extractor was unnecessary; the instrument caused a subdural bleed that resulted in the child’s developmental delays.
PHYSICIAN’S DEFENSE Vacuum extraction was necessary because the baby was not progressing down the birth canal and was beginning to show signs of distress. Vacuum extraction did not cause the child’s injuries.
VERDICT A confidential South Carolina settlement was reached during jury deliberations.
Suture fails to dissolve; fistula develops
A WOMAN UNDERWENT SURGERY for uterine fibroids, during which injury to the bladder was repaired with a single suture.
A few weeks later, she developed abdominal pain, blood in her urine, and urinary incontinence. It was determined that the suture had not dissolved, and caused obstruction of the right ureter and kidney. A vesicovaginal fistula developed when the stitch migrated through the anterior wall of the vagina.
PATIENT’S CLAIM The gynecologist was at fault for injuring the bladder during surgery, and repairing it with a nondissolving suture.
PHYSICIAN’S DEFENSE Injury to the bladder and ureters is a known risk of the procedure. The correct type of suture was used; it was supposed to dissolve. The gynecologist tested the bladder and ureters using Indigo carmine-based dye before closing.
Over time, as the suture failed to dissolve, scar tissue occluded the ureter. Subsequent surgery returned the patient to baseline health.
VERDICT A Pennsylvania defense verdict was returned.
Baby stillborn. Vasa previa missed?
ULTRASONOGRAPHY REVEALED that the patient probably had a vasa previa. Her ObGyn referred her to an OB specialist, who ordered a second scan, which ruled out vasa previa. A month later, the patient was taken to the hospital with vaginal bleeding. It was determined that she was in labor, and her ObGyn performed a cesarean delivery. The baby was stillborn.
PATIENT’S CLAIM Both ObGyns failed to diagnose a vasa previa, which caused the stillbirth. Proper diagnosis would have allowed for cesarean delivery before labor began, resulting in a successful birth.
PHYSICIANS’ DEFENSE The pregnancy was properly managed. Vasa previa had been ruled out by ultrasonography. Placental abruption or a fetal-maternal hemorrhage was responsible for the stillbirth.
VERDICT A Kentucky defense verdict was returned.
Delay in delivery, then uterine infection, then hysterectomy
A 29-YEAR-OLD WOMAN was 34 weeks’ pregnant with her third child when she suspected that her water broke, and went to the hospital. Testing revealed the membranes had ruptured, but the ObGyn elected to delay delivery.
Amniotic fluid continued to leak for 5 days when suddenly the woman’s temperature spiked. A healthy baby was delivered by cesarean section 24 hours later.
After delivery, an intrauterine infection was diagnosed in the mother. She was transferred to another hospital, where she underwent a hysterectomy.
PATIENT’S CLAIM The ObGyn was negligent in failing to deliver the child when membranes initially broke. Leaking amniotic fluid contributed to the uterine infection.
PHYSICIAN’S DEFENSE It was appropriate to allow the pregnancy to continue because the fetus was premature. Infection could have occurred regardless of when delivery was performed.
VERDICT A $25,000 Mississippi verdict was returned.
What caused this child’s brain damage?
DURING PROLONGED DELIVERY, the physician assistant and residents in charge of labor and delivery noted meconiumstained amniotic fluid discharge. When advised, the mother’s ObGyn directed the hospital staff to perform amnioinfusion. The child was born vaginally several hours later and determined to have suffered brain damage.
The child cannot swallow and receives nutrition through a feeding tube. She cannot speak, is confined to a wheelchair, and has the cognitive function of an 18-month old.