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    Legally Speaking: Did induction cause this uterine rupture?




    Andrew I Kaplan, Esq, is a partner at Aaronson, Rappaport, Feinstein & Deutsch, LLP in New York City, specializing in medical malpractice defense and healthcare litigation.

    In September 2011, a woman learned she was pregnant with her first child and visited ob/gyn Dr A. At some point during the pregnancy, Dr A diagnosed fibroids and indicated that if they grew too large, the patient would need to deliver via cesarean. In the early morning of April 29, 2012, the patient’s water broke and her husband brought her to the hospital at approximately 4 a.m. The patient—the plaintiff in this case—was at 35 weeks’ gestation.

    Dr A had an agreement with defendant ob Dr B to cover each other's patients, and it was Dr. B who was the attending physician managing the plaintiff’s care when she arrived at the hospital. At the time, Dr B was the director of ambulatory care as well. The plaintiff was examined by a resident upon arrival at 4 am and was next seen by Dr B at about 5:30 a.m. Because the plaintiff had tested positive for Group-B streptococcus (GBS), Dr B ordered prophylactic antibiotics and indicated that the plaintiff would need to be admitted. At approximately 11:00 a.m., Dr. B examined the womanand indicated she would be placing a dinoprostone to prepare the plaintiff’s nonfavorable cervix for oxytocin administration later. Dr. B then informed the residents of the examination and placement of the dinoprostone and said that the plaintiff could receive an epidural if she complained of pain. At around 2 p.m., the plaintiff complained of pain and an epidural was administered.

    Throughout the day, the labor and delivery nurses monitored the plaintiff, checking the fetal heart rate (FHR) monitor and palpating as necessary at 2:30, 4:05, and 5:43. In addition, the residents periodically assessed the plaintiff, but did not perform a vaginal examination as they were directed not to do so by Dr. B because of the plaintiff’s GBS status. Specifically, to prevent exposing the plaintiff to any further infection, Dr B had instructed that she should be examined only if there was tachysystole, a FHR tracing abnormality, or active labor. From approximately 3 p.m. until 7 p.m., the plaintiff was having contractions every 2 to 4 minutes, the FHR tracings were reassuring, and she plaintiff was not experiencing pain. Thus, there was no need to conduct a vaginal examination.


    Andrew I. Kaplan, Esq
    Mr. Kaplan is a partner at Aaronson, Rappaport, Feinstein & Deutsch, LLP, specializing in medical malpractice defense and healthcare ...


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