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    Maternal death from intracranial hemorrhage

    Case hinges on family physician’s knowledge of obstetric conditions

     

    Failure to monitor IUGR alleged

    A 39-year-old Missouri woman had her first prenatal appointment when she was at 21 weeks’ gestation. Due to advanced maternal age and a history of previous intrauterine growth restriction (IUGR), her care was transferred to a high-risk pregnancy clinic. At her next prenatal appointment she tested positive for marijuana and it was noted in her record that she was at risk of repeat IUGR. An U/S performed at 25 weeks’ gestation noted the fetal weight was in the 11th–25th percentile and amniotic fluid was normal. The patient missed her next prenatal appointment and was seen at 28 weeks, at which time she had increased BP and headache.

    The patient missed her next 5 weeks of appointments and returned at 33 weeks’ pregnant with a blood pressure of 160/97, normal FHR, positive fetal movement, and a fundal height measurement revealing a 3-cm discrepancy in dates and size. She was scheduled for FHR testing the next day and a nonstress test was nonreassuring. She was instructed to go to the hospital for admission and arrived there about 1 hour later. The FHR continued to be nonreassuring and an U/S was done and revealed an IUGR fetus and oligohydramnios. An emergency cesarean was performed and the infant delivered 16 minutes later. The Apgars were 4 and 9. The infant had grade III and grade IV intraventricular hemorrhages, a positive screen for marijuana, and white matter brain damage. The child now suffers developmental delays, cognitive deficits, and breakthrough seizures.

    The woman sued the high-risk pregnancy clinic, alleging negligence in the failure to implement a plan at her first prenatal visit to monitor her for IUGR based on her history; failure to advise her of that risk; failure to perform fundal height measurements and U/S at specific intervals; and failure to perform a nonstress test at her 33-week prenatal visit, which she claimed would have led to earlier hospital admission, earlier delivery, and a healthy baby.

    Related: Detection and surveillance of IUGR

    The physicians argued that the patient was noncompliant and missed many of her prenatal appointments and she also continued to smoke marijuana throughout the pregnancy. They claimed the correct tests were ordered and performed, and that delivery occurred in a timely fashion. They also argued that the problems suffered by the child were a result of prematurity and damage that occurred during the weeks of missed appointments.

    The verdict: The case settled for $2.75 million.

    Rectovaginal fistula after vaginal delivery

    An ob/gyn delivered the child of a 31-year-old New York woman. During delivery the obstetrician found the umbilical cord wrapped around the fetal head, and to safely deliver the infant he performed an episiotomy. In the days following delivery the patient noted gas from the vagina. The obstetrician suggested it would resolve itself without treatment. The patient became pregnant right after this delivery and was evaluated by a midwife. She again mentioned an odorous discharge but it was not addressed. During delivery of the second child the obstetrician determined that the patient had a rectovaginal fistula. She subsequently underwent 13 operations to repair the fistula.

    The woman sued the obstetrician and claimed the fistula was a result of the episiotomy he performed at the first delivery. She asserted that the episiotomy should never have been performed and that the obstetrician should have diagnosed and treated the fistula prior to the second delivery or she should have had a cesarean for the second child.

    The obstetrician opined that the patient’s record did not show any report of an odorous discharge until after the second delivery.

    The verdict: The jury found for the patient and entered a judgment in the amount of $10 million for past pain and suffering and $40 million for future pain and suffering, for a total verdict of $50 million.

    NEXT: Alleged miscalculation of due date

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