Medicolegal Issues

Uterine rupture after unplanned VBAC

Notable judgments and settlements


 

Uterine rupture after unplanned VBAC
A 34-year-old woman went into labor 9 days before a scheduled repeat cesarean. She gave birth vaginally to a healthy baby.

After delivery, the mother complained of sharp abdominal pain that she rated 10/10 on the pain scale; pain was unrelieved by morphine. Moderate bleeding was noted. After the ObGyn performed a manual exploration and curette procedure, uterine scar rupture was ruled out and the patient was treated for uterine atony. For 90 minutes, the patient was hypotensive and tachycardic with moderate bleeding. Her hemoglobin and hematocrit levels dropped lower than before delivery, and she went into cardiac arrest. After resuscitation, she received a blood transfusion. A second ObGyn took over her care.

Although the patient received 7 U each of packed red blood cells (PRBC) and fresh frozen plasma (FFP) over the next 5 hours, she continued to have low hemoglobin and hematocrit values. Bleeding was noted as sporadic. Shortly after a decision was made to perform a hysterectomy, the patient experienced cardiac arrest and was successfully resuscitated. At surgery, a uterine rupture was noted. She received 14 U each of PRBC and FFP during surgery. Bleeding stopped after the hysterectomy, but the patient remained on a ventilator for 9 days, suffered renal failure and adrenal insufficiency, and went into cardiac arrest twice more.

The patient suffered brain damage and has poor memory function. She had to relearn to walk, talk, and perform normal life tasks. She underwent a kidney transplant because of permanent kidney damage and will require additional kidney transplants during her lifetime.

PATIENT’S CLAIM The ObGyn failed to recognize uterine scar rupture and perform an immediate hysterectomy. The operative report from the hysterectomy used the words uterine scar “rupture” and “dehiscence” interchangeably as the source of bleeding and hemorrhagic shock.

DEFENDANTS’ DEFENSE The patient’s injury was a prior uterine scar “dehiscence” and not a complete rupture; conservative measures were appropriate.

VERDICT A $4 million Virginia verdict was returned that was reduced to $2 million under the state cap.

Woman in vegetative state after cystectomy
Two days after ovarian cystectomy, a 55-year-old woman was returned to the operating room for primary repair of a colon injury. Postoperatively, a colovesical fistula developed. During a third operation, the patient suffered cardiac arrest and sustained brain damage due to lack of oxygen. She remains in a vegetative state.

PATIENT’S CLAIM The colon injury was not detected or treated in a timely manner. A temporary colostomy should have been performed. Metoprolol tartrate, given after the third operation, caused cardiac arrest.

DEFENDANTS’ DEFENSE A settlement was reached during trial.

VERDICT A $2.725 million New Jersey settlement was reached with two physicians, a nurse, and the hospital. A third physician was released from liability.

Breast surgery leaves triangular areola
Cosmetic breast surgery on a 37-year-old woman included insertion of implants, a mastopexy, and reduction of the areolae. After surgery, one areola appeared triangularly shaped. After several months, the patient saw another plastic surgeon who surgically removed the undesirable tissue to reshape the areola.

PATIENT’S CLAIM Postoperatively, the plastic surgeon explained that the patient’s nipples were surrounded by hyperpigmented tissue that had to be removed during a second operation. The patient signed a consent to surgery, but the document did not explain that additional procedures could be necessary.

PHYSICIAN’S DEFENSE The signed consent form included language that additional procedures could be necessary. The plastic surgeon would have performed a free correction of the areola, but the procedure could not occur until the patient’s breasts had healed. In the meantime, the patient went to another surgeon.

VERDICT A New York defense verdict was returned.

Operative report contested
A gynecologist performed a hysterectomy on a 43-year-old woman. Two days after surgery, she was found to have an obstruction of the left ureter and a bladder injury. Extensive treatment was required to treat the injury.

PATIENT’S CLAIM Surgery was performed in a negligent manner. The surgical report states that the arteries were clamped and sutured before the ureters had been identified. The ureter injury was caused by the improper use of a clamp.

DEFENDANTS’ DEFENSE The gynecologist claimed that the proper sequence was used during surgery; an assisting physician may have erroneously documented the sequence of events. Surgery was complicated by fibroids that distorted the patient’s anatomy. The injury was a known risk of the procedure. Damage to the ureter could have been caused by a kink in the ureter or by treatment given later by a urologist.

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