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Fetal injury from repeat vaginal delivery

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Undisclosed North Carolina venue

A woman who had already delivered a child with shoulder dystocia that resulted in Erb’s palsy was pregnant for a second time and feared it would happen again. The mother expressed her fear to her obstetrician and inquired about a cesarean section. All prenatal assessments for fetal size indicated that the infant was large.

When the mother presented for delivery, a vaginal delivery was attempted. Maneuvers to relieve resulting shoulder dystocia were ineffective. A cesarean incision was then made; cephalic replacement was unsuccessful.

The infant was delivered with a broken neck, broken clavicle, and broken arm. The child also had massive brain damage and cortical blindness as a result of brain hypoxia. The child is quadriplegic and dependent on a ventilator and gastrostomy tube.

  • The parties settled for $13.5 million after a fourth formal mediation.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.
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Undisclosed North Carolina venue

A woman who had already delivered a child with shoulder dystocia that resulted in Erb’s palsy was pregnant for a second time and feared it would happen again. The mother expressed her fear to her obstetrician and inquired about a cesarean section. All prenatal assessments for fetal size indicated that the infant was large.

When the mother presented for delivery, a vaginal delivery was attempted. Maneuvers to relieve resulting shoulder dystocia were ineffective. A cesarean incision was then made; cephalic replacement was unsuccessful.

The infant was delivered with a broken neck, broken clavicle, and broken arm. The child also had massive brain damage and cortical blindness as a result of brain hypoxia. The child is quadriplegic and dependent on a ventilator and gastrostomy tube.

  • The parties settled for $13.5 million after a fourth formal mediation.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.

Undisclosed North Carolina venue

A woman who had already delivered a child with shoulder dystocia that resulted in Erb’s palsy was pregnant for a second time and feared it would happen again. The mother expressed her fear to her obstetrician and inquired about a cesarean section. All prenatal assessments for fetal size indicated that the infant was large.

When the mother presented for delivery, a vaginal delivery was attempted. Maneuvers to relieve resulting shoulder dystocia were ineffective. A cesarean incision was then made; cephalic replacement was unsuccessful.

The infant was delivered with a broken neck, broken clavicle, and broken arm. The child also had massive brain damage and cortical blindness as a result of brain hypoxia. The child is quadriplegic and dependent on a ventilator and gastrostomy tube.

  • The parties settled for $13.5 million after a fourth formal mediation.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.
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Woman delivers fetus’s head into toilet

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Fulton County (Ga) State Court

A woman at 20 weeks’ gestation went to the hospital with complaints of cramping and a lack of fetal movement. After an ultrasound was performed, the on-call obstetrician diagnosed intrauterine fetal demise.

The next day the woman’s own obstetrician took over care. Before he could perform the planned vaginal delivery of the nonviable fetus and placenta, however, rapid cervical dilation to 6 or 7 cm led to a bulging bag of waters, and the small fetus had almost completely delivered except the head, which separated with normal traction and remained inside the uterus. Oxytocin was given to stimulate the process, without success. An evacuation procedure was performed to remove the remaining products of conception. The procedure was thought to be successful, and the patient was discharged.

However, the next day the woman was bleeding and felt unusual pressure and delivered part of the fetus’s head into the toilet. The EMS crew placed the partial head into a zip-lock bag and transported it with the woman to the hospital, where any remaining products of conception could be removed.

In suing, the woman claimed negligence in the decapitation of the fetus and negligent performance of the dilation and evacuation. She also claimed to have posttraumatic stress disorder from seeing the partial head in the toilet.

The obstetrician alleged that the separation of the fetal head was unavoidable due to the woman’s abnormal uterine anatomy and that she was upset at the loss of the fetus, but did not suffer posttraumatic stress disorder.

  • A defense verdict was returned.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.
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Fulton County (Ga) State Court

A woman at 20 weeks’ gestation went to the hospital with complaints of cramping and a lack of fetal movement. After an ultrasound was performed, the on-call obstetrician diagnosed intrauterine fetal demise.

The next day the woman’s own obstetrician took over care. Before he could perform the planned vaginal delivery of the nonviable fetus and placenta, however, rapid cervical dilation to 6 or 7 cm led to a bulging bag of waters, and the small fetus had almost completely delivered except the head, which separated with normal traction and remained inside the uterus. Oxytocin was given to stimulate the process, without success. An evacuation procedure was performed to remove the remaining products of conception. The procedure was thought to be successful, and the patient was discharged.

However, the next day the woman was bleeding and felt unusual pressure and delivered part of the fetus’s head into the toilet. The EMS crew placed the partial head into a zip-lock bag and transported it with the woman to the hospital, where any remaining products of conception could be removed.

In suing, the woman claimed negligence in the decapitation of the fetus and negligent performance of the dilation and evacuation. She also claimed to have posttraumatic stress disorder from seeing the partial head in the toilet.

The obstetrician alleged that the separation of the fetal head was unavoidable due to the woman’s abnormal uterine anatomy and that she was upset at the loss of the fetus, but did not suffer posttraumatic stress disorder.

  • A defense verdict was returned.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.

Fulton County (Ga) State Court

A woman at 20 weeks’ gestation went to the hospital with complaints of cramping and a lack of fetal movement. After an ultrasound was performed, the on-call obstetrician diagnosed intrauterine fetal demise.

The next day the woman’s own obstetrician took over care. Before he could perform the planned vaginal delivery of the nonviable fetus and placenta, however, rapid cervical dilation to 6 or 7 cm led to a bulging bag of waters, and the small fetus had almost completely delivered except the head, which separated with normal traction and remained inside the uterus. Oxytocin was given to stimulate the process, without success. An evacuation procedure was performed to remove the remaining products of conception. The procedure was thought to be successful, and the patient was discharged.

However, the next day the woman was bleeding and felt unusual pressure and delivered part of the fetus’s head into the toilet. The EMS crew placed the partial head into a zip-lock bag and transported it with the woman to the hospital, where any remaining products of conception could be removed.

In suing, the woman claimed negligence in the decapitation of the fetus and negligent performance of the dilation and evacuation. She also claimed to have posttraumatic stress disorder from seeing the partial head in the toilet.

The obstetrician alleged that the separation of the fetal head was unavoidable due to the woman’s abnormal uterine anatomy and that she was upset at the loss of the fetus, but did not suffer posttraumatic stress disorder.

  • A defense verdict was returned.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.
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Did OB ignore risk factors?

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Harris County (Tex) District Court

A woman with gestational diabetes, significant maternal weight gain, and a prior macrosomic delivery presented for delivery, which became complicated by shoulder dystocia. The child suffered brachial plexus injury, leading to paralysis of her left arm and hand.

In suing, the plaintiffs alleged that the doctor used excessive force in delivering the child, and claimed he failed to appreciate the mother’s risk factors for a complicated delivery.

  • The jury returned a defense verdict.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.
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Harris County (Tex) District Court

A woman with gestational diabetes, significant maternal weight gain, and a prior macrosomic delivery presented for delivery, which became complicated by shoulder dystocia. The child suffered brachial plexus injury, leading to paralysis of her left arm and hand.

In suing, the plaintiffs alleged that the doctor used excessive force in delivering the child, and claimed he failed to appreciate the mother’s risk factors for a complicated delivery.

  • The jury returned a defense verdict.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.

Harris County (Tex) District Court

A woman with gestational diabetes, significant maternal weight gain, and a prior macrosomic delivery presented for delivery, which became complicated by shoulder dystocia. The child suffered brachial plexus injury, leading to paralysis of her left arm and hand.

In suing, the plaintiffs alleged that the doctor used excessive force in delivering the child, and claimed he failed to appreciate the mother’s risk factors for a complicated delivery.

  • The jury returned a defense verdict.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.
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Small-bowel transection causes death

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Clark County (Nev) District Court

A woman who underwent an abdominal hysterectomy died. The family claimed that during the surgery the physician transected the small bowel and then failed to recognize and treat the injury in a timely manner, leading to the woman’s death. The family also claimed lack of informed consent.

The physician claimed that death was a known complication of the procedure.

  • The jury returned a defense verdict.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.
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Clark County (Nev) District Court

A woman who underwent an abdominal hysterectomy died. The family claimed that during the surgery the physician transected the small bowel and then failed to recognize and treat the injury in a timely manner, leading to the woman’s death. The family also claimed lack of informed consent.

The physician claimed that death was a known complication of the procedure.

  • The jury returned a defense verdict.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.

Clark County (Nev) District Court

A woman who underwent an abdominal hysterectomy died. The family claimed that during the surgery the physician transected the small bowel and then failed to recognize and treat the injury in a timely manner, leading to the woman’s death. The family also claimed lack of informed consent.

The physician claimed that death was a known complication of the procedure.

  • The jury returned a defense verdict.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.
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What caused leak: UTI or PPROM?

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Hamilton County (Ohio) Common Pleas Court

Upon the discovery in the middle of the night that she was leaking fluid, a woman at 20 weeks’ gestation called her obstetrician’s office and spoke with the covering physician. The doctor diagnosed a urinary tract infection (UTI) and told the patient to come into the office the next day. Urine culture taken at that visit was normal.

The woman continued to leak fluid for the next 2 weeks. A visit with her regular obstetrician later that month passed without incident, but at a second visit the physician suspected ruptured membranes. The doctor admitted the woman to the hospital, where preterm premature rupture of membranes (PPROM) was confirmed. The child was delivered at 24 weeks’ gestation and died 2 days after birth.

The woman sued the physician who took her late-night call, claiming the doctor was negligent in failing to diagnose ruptured membranes.

The defendant argued that the woman’s symptoms were consistent with UTI, and claimed the membranes had not yet ruptured at the time of the initial phone call.

  • The jury returned a defense verdict.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.
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Hamilton County (Ohio) Common Pleas Court

Upon the discovery in the middle of the night that she was leaking fluid, a woman at 20 weeks’ gestation called her obstetrician’s office and spoke with the covering physician. The doctor diagnosed a urinary tract infection (UTI) and told the patient to come into the office the next day. Urine culture taken at that visit was normal.

The woman continued to leak fluid for the next 2 weeks. A visit with her regular obstetrician later that month passed without incident, but at a second visit the physician suspected ruptured membranes. The doctor admitted the woman to the hospital, where preterm premature rupture of membranes (PPROM) was confirmed. The child was delivered at 24 weeks’ gestation and died 2 days after birth.

The woman sued the physician who took her late-night call, claiming the doctor was negligent in failing to diagnose ruptured membranes.

The defendant argued that the woman’s symptoms were consistent with UTI, and claimed the membranes had not yet ruptured at the time of the initial phone call.

  • The jury returned a defense verdict.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.

Hamilton County (Ohio) Common Pleas Court

Upon the discovery in the middle of the night that she was leaking fluid, a woman at 20 weeks’ gestation called her obstetrician’s office and spoke with the covering physician. The doctor diagnosed a urinary tract infection (UTI) and told the patient to come into the office the next day. Urine culture taken at that visit was normal.

The woman continued to leak fluid for the next 2 weeks. A visit with her regular obstetrician later that month passed without incident, but at a second visit the physician suspected ruptured membranes. The doctor admitted the woman to the hospital, where preterm premature rupture of membranes (PPROM) was confirmed. The child was delivered at 24 weeks’ gestation and died 2 days after birth.

The woman sued the physician who took her late-night call, claiming the doctor was negligent in failing to diagnose ruptured membranes.

The defendant argued that the woman’s symptoms were consistent with UTI, and claimed the membranes had not yet ruptured at the time of the initial phone call.

  • The jury returned a defense verdict.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.
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Is misoprostol wrong for induction?

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Charlottesville (Va) Circuit Court

A 32-year-old woman at 38 2/7’s weeks’ gestation presented to a hospital for a scheduled induction due to gallstone pain and previous difficult delivery.

Her obstetrician gave 50 mg of misoprostol vaginally, but the woman’s cervix failed to dilate. Three hours later, the physician requested that a second ObGyn administer another 50-mg dose. Though the woman had contractions and increasing pain, cervical dilation did not begin for another 1.5 hours, after which steady progression occurred. She received an epidural and vaginally delivered a healthy infant girl.

Postpartum, the woman experienced rapid bleeding and passed a clot. Following oxytocin administration, her blood pressure dropped, after which a cervical tear was discovered. On exploratory laparotomy, the tear was found to extend to the woman’s uterus, requiring a hysterectomy. The procedure was successful and the woman made a full recovery.

In suing, the plaintiff claimed the tear stemmed from hyperstimulation due to excessive doses of misoprostol. She claimed the agent was not an appropriate choice since it is not approved for labor induction, and argued that the obstetricians failed to properly monitor her progress. She also argued that she did not provide informed consent.

The defense maintained that the tear was unrelated to the use of misoprostol, which they noted to be an appropriate agent that was properly administered.

  • The jury returned a defense verdict.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.
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Charlottesville (Va) Circuit Court

A 32-year-old woman at 38 2/7’s weeks’ gestation presented to a hospital for a scheduled induction due to gallstone pain and previous difficult delivery.

Her obstetrician gave 50 mg of misoprostol vaginally, but the woman’s cervix failed to dilate. Three hours later, the physician requested that a second ObGyn administer another 50-mg dose. Though the woman had contractions and increasing pain, cervical dilation did not begin for another 1.5 hours, after which steady progression occurred. She received an epidural and vaginally delivered a healthy infant girl.

Postpartum, the woman experienced rapid bleeding and passed a clot. Following oxytocin administration, her blood pressure dropped, after which a cervical tear was discovered. On exploratory laparotomy, the tear was found to extend to the woman’s uterus, requiring a hysterectomy. The procedure was successful and the woman made a full recovery.

In suing, the plaintiff claimed the tear stemmed from hyperstimulation due to excessive doses of misoprostol. She claimed the agent was not an appropriate choice since it is not approved for labor induction, and argued that the obstetricians failed to properly monitor her progress. She also argued that she did not provide informed consent.

The defense maintained that the tear was unrelated to the use of misoprostol, which they noted to be an appropriate agent that was properly administered.

  • The jury returned a defense verdict.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.

Charlottesville (Va) Circuit Court

A 32-year-old woman at 38 2/7’s weeks’ gestation presented to a hospital for a scheduled induction due to gallstone pain and previous difficult delivery.

Her obstetrician gave 50 mg of misoprostol vaginally, but the woman’s cervix failed to dilate. Three hours later, the physician requested that a second ObGyn administer another 50-mg dose. Though the woman had contractions and increasing pain, cervical dilation did not begin for another 1.5 hours, after which steady progression occurred. She received an epidural and vaginally delivered a healthy infant girl.

Postpartum, the woman experienced rapid bleeding and passed a clot. Following oxytocin administration, her blood pressure dropped, after which a cervical tear was discovered. On exploratory laparotomy, the tear was found to extend to the woman’s uterus, requiring a hysterectomy. The procedure was successful and the woman made a full recovery.

In suing, the plaintiff claimed the tear stemmed from hyperstimulation due to excessive doses of misoprostol. She claimed the agent was not an appropriate choice since it is not approved for labor induction, and argued that the obstetricians failed to properly monitor her progress. She also argued that she did not provide informed consent.

The defense maintained that the tear was unrelated to the use of misoprostol, which they noted to be an appropriate agent that was properly administered.

  • The jury returned a defense verdict.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.
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Monitor delay blamed for cerebral palsy

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<court>Dade County (Fla) Circuit Court</court>

Labor induction was scheduled for a gravida with gestational diabetes due to concerns of macrosomia. Once induced, however, labor progressed slowly.

When fetal monitoring revealed no fetal heart rate, the nurse suspected a problem with the monitor. After adjusting the monitor, she discovered the antisurge box had been removed, and left the room to get another.

Once the monitor was again operating properly, a fetal heart rate was still not detected. An emergency cesarean was ordered, but the child was born with severe cerebral palsy.

The plaintiffs sued the physician and hospital, arguing that the nurse should have notified the doctor immediately upon discovering no fetal heart rate. The delay caused by her attempt to fix the monitor, they argued, led to the child’s injury.

The defense claimed that the mother’s uncontrolled gestational diabetes played a role in the child’s injury, and argued that an intrauterine infection may also have contributed to the outcome.

  • The parties settled for $4 million.

The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.

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<court>Dade County (Fla) Circuit Court</court>

Labor induction was scheduled for a gravida with gestational diabetes due to concerns of macrosomia. Once induced, however, labor progressed slowly.

When fetal monitoring revealed no fetal heart rate, the nurse suspected a problem with the monitor. After adjusting the monitor, she discovered the antisurge box had been removed, and left the room to get another.

Once the monitor was again operating properly, a fetal heart rate was still not detected. An emergency cesarean was ordered, but the child was born with severe cerebral palsy.

The plaintiffs sued the physician and hospital, arguing that the nurse should have notified the doctor immediately upon discovering no fetal heart rate. The delay caused by her attempt to fix the monitor, they argued, led to the child’s injury.

The defense claimed that the mother’s uncontrolled gestational diabetes played a role in the child’s injury, and argued that an intrauterine infection may also have contributed to the outcome.

  • The parties settled for $4 million.

The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.

<court>Dade County (Fla) Circuit Court</court>

Labor induction was scheduled for a gravida with gestational diabetes due to concerns of macrosomia. Once induced, however, labor progressed slowly.

When fetal monitoring revealed no fetal heart rate, the nurse suspected a problem with the monitor. After adjusting the monitor, she discovered the antisurge box had been removed, and left the room to get another.

Once the monitor was again operating properly, a fetal heart rate was still not detected. An emergency cesarean was ordered, but the child was born with severe cerebral palsy.

The plaintiffs sued the physician and hospital, arguing that the nurse should have notified the doctor immediately upon discovering no fetal heart rate. The delay caused by her attempt to fix the monitor, they argued, led to the child’s injury.

The defense claimed that the mother’s uncontrolled gestational diabetes played a role in the child’s injury, and argued that an intrauterine infection may also have contributed to the outcome.

  • The parties settled for $4 million.

The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.

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Insufficient testing for thalassemia carrier?

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Undisclosed Massachusetts venue

A woman of Mediterranean descent with chronic anemia presented to a nurse practitioner for a birth control injection. In the woman’s chart—which the supervising physician also signed—the nurse practitioner expressed concern that the patient might suffer from thalassemia, but the clinicians did not evaluate her condition or advise her of the pregnancy risks associated with the disorder.

Two years later the woman became pregnant. At her first prenatal visit, both her family history and blood work were noted to be worrisome relative to thalassemia. Again, however, no steps were taken to evaluate either mother or fetus.

The woman gave birth to an infant daughter who was subsequently diagnosed with thalassemia major, which requires her to undergo blood transfusions every 4 weeks and will likely shorten her life expectancy.

In suing, the plaintiff argued that clinicians should have tested the mother and father for the thalassemia trait, which both were found to have after the child’s diagnosis. Further, she claimed, tests should have been performed to determine whether the fetus had the disorder.

The defense argued that the incidence of thalassemia transmission from mother to fetus is very low and maintained the woman was aware of her status as a thalassemia carrier and knew the risks involved with pregnancy.

  • The parties settled for $900,000.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.
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Undisclosed Massachusetts venue

A woman of Mediterranean descent with chronic anemia presented to a nurse practitioner for a birth control injection. In the woman’s chart—which the supervising physician also signed—the nurse practitioner expressed concern that the patient might suffer from thalassemia, but the clinicians did not evaluate her condition or advise her of the pregnancy risks associated with the disorder.

Two years later the woman became pregnant. At her first prenatal visit, both her family history and blood work were noted to be worrisome relative to thalassemia. Again, however, no steps were taken to evaluate either mother or fetus.

The woman gave birth to an infant daughter who was subsequently diagnosed with thalassemia major, which requires her to undergo blood transfusions every 4 weeks and will likely shorten her life expectancy.

In suing, the plaintiff argued that clinicians should have tested the mother and father for the thalassemia trait, which both were found to have after the child’s diagnosis. Further, she claimed, tests should have been performed to determine whether the fetus had the disorder.

The defense argued that the incidence of thalassemia transmission from mother to fetus is very low and maintained the woman was aware of her status as a thalassemia carrier and knew the risks involved with pregnancy.

  • The parties settled for $900,000.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.

Undisclosed Massachusetts venue

A woman of Mediterranean descent with chronic anemia presented to a nurse practitioner for a birth control injection. In the woman’s chart—which the supervising physician also signed—the nurse practitioner expressed concern that the patient might suffer from thalassemia, but the clinicians did not evaluate her condition or advise her of the pregnancy risks associated with the disorder.

Two years later the woman became pregnant. At her first prenatal visit, both her family history and blood work were noted to be worrisome relative to thalassemia. Again, however, no steps were taken to evaluate either mother or fetus.

The woman gave birth to an infant daughter who was subsequently diagnosed with thalassemia major, which requires her to undergo blood transfusions every 4 weeks and will likely shorten her life expectancy.

In suing, the plaintiff argued that clinicians should have tested the mother and father for the thalassemia trait, which both were found to have after the child’s diagnosis. Further, she claimed, tests should have been performed to determine whether the fetus had the disorder.

The defense argued that the incidence of thalassemia transmission from mother to fetus is very low and maintained the woman was aware of her status as a thalassemia carrier and knew the risks involved with pregnancy.

  • The parties settled for $900,000.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.
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Did delayed cesarean cause uterine rupture?

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Plymouth County (Mass) Superior Court

A woman was admitted in the evening for induction of labor for a planned vaginal birth after cesarean (VBAC) delivery. Normal labor did not ensue after oxytocin was administered in the morning, and the fetal heart rate monitor strips revealed uterine hyperactivity and fetal distress, which worsened during the day.

The nurse assigned to the woman asked the charge nurse for advice; she was told to call the obstetrician. The physician claimed the labor was progressing satisfactorily and ordered continuation of the oxytocin. After alerting the charge nurse at 3:30 PM, the evening shift nurse and the charge nurse stopped the oxytocin at 4:00 PMand called the obstetrician at 4:10 PM. The physician returned to the hospital but did not order a cesarean until 20 minutes later.

The infant had a seizure shortly after birth, and the physician diagnosed hypoxic brain injury as a result of uterine rupture. The baby died 3 weeks later.

In suing, the woman claimed she was not advised of the risks of VBAC delivery, that the charge nurse failed to recognize early signs of fetal distress, that a cesarean should have been ordered much earlier in the day, and that it was negligent to allow labor to continue into the afternoon.

The obstetrician claimed the infant was healthy during early labor and faulted the evening nurse for not calling him back to the hospital sooner. The nurses claimed the physician had superior knowledge and said they could not be expected to recognize distress on the fetal monitor if the obstetrician could not.

  • The parties reached a $1.25 million settlement.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.
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Plymouth County (Mass) Superior Court

A woman was admitted in the evening for induction of labor for a planned vaginal birth after cesarean (VBAC) delivery. Normal labor did not ensue after oxytocin was administered in the morning, and the fetal heart rate monitor strips revealed uterine hyperactivity and fetal distress, which worsened during the day.

The nurse assigned to the woman asked the charge nurse for advice; she was told to call the obstetrician. The physician claimed the labor was progressing satisfactorily and ordered continuation of the oxytocin. After alerting the charge nurse at 3:30 PM, the evening shift nurse and the charge nurse stopped the oxytocin at 4:00 PMand called the obstetrician at 4:10 PM. The physician returned to the hospital but did not order a cesarean until 20 minutes later.

The infant had a seizure shortly after birth, and the physician diagnosed hypoxic brain injury as a result of uterine rupture. The baby died 3 weeks later.

In suing, the woman claimed she was not advised of the risks of VBAC delivery, that the charge nurse failed to recognize early signs of fetal distress, that a cesarean should have been ordered much earlier in the day, and that it was negligent to allow labor to continue into the afternoon.

The obstetrician claimed the infant was healthy during early labor and faulted the evening nurse for not calling him back to the hospital sooner. The nurses claimed the physician had superior knowledge and said they could not be expected to recognize distress on the fetal monitor if the obstetrician could not.

  • The parties reached a $1.25 million settlement.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.

Plymouth County (Mass) Superior Court

A woman was admitted in the evening for induction of labor for a planned vaginal birth after cesarean (VBAC) delivery. Normal labor did not ensue after oxytocin was administered in the morning, and the fetal heart rate monitor strips revealed uterine hyperactivity and fetal distress, which worsened during the day.

The nurse assigned to the woman asked the charge nurse for advice; she was told to call the obstetrician. The physician claimed the labor was progressing satisfactorily and ordered continuation of the oxytocin. After alerting the charge nurse at 3:30 PM, the evening shift nurse and the charge nurse stopped the oxytocin at 4:00 PMand called the obstetrician at 4:10 PM. The physician returned to the hospital but did not order a cesarean until 20 minutes later.

The infant had a seizure shortly after birth, and the physician diagnosed hypoxic brain injury as a result of uterine rupture. The baby died 3 weeks later.

In suing, the woman claimed she was not advised of the risks of VBAC delivery, that the charge nurse failed to recognize early signs of fetal distress, that a cesarean should have been ordered much earlier in the day, and that it was negligent to allow labor to continue into the afternoon.

The obstetrician claimed the infant was healthy during early labor and faulted the evening nurse for not calling him back to the hospital sooner. The nurses claimed the physician had superior knowledge and said they could not be expected to recognize distress on the fetal monitor if the obstetrician could not.

  • The parties reached a $1.25 million settlement.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.
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Vaginal delivery leads to quadriplegia

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Suffolk County (NY) Supreme Court

A third-trimester sonogram showed the fetus in an oblique transverse lie, indicating possible breech presentation, along with hyperextension of the fetus’ spinal cord, indicating the fetus was at high risk for neck injury from a vaginal delivery. The radiologist conveyed the sonogram findings to a nurse, but not the woman’s obstetrician.

The next day the woman began having contractions and went to the emergency room. No attempt was made to obtain the sonogram from the day before. Despite a double-footling breech presentation, the obstetrician elected not to perform a cesarean section. After vaginal delivery, the infant was quadriplegic and had severe hypoxic brain damage.

In suing, the woman claimed her physician was negligent in choice of delivery and that the flexing and rotating of the infant’s head caused a near-complete transection of the spinal cord.

  • The case settled for $11.8 million.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.
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Suffolk County (NY) Supreme Court

A third-trimester sonogram showed the fetus in an oblique transverse lie, indicating possible breech presentation, along with hyperextension of the fetus’ spinal cord, indicating the fetus was at high risk for neck injury from a vaginal delivery. The radiologist conveyed the sonogram findings to a nurse, but not the woman’s obstetrician.

The next day the woman began having contractions and went to the emergency room. No attempt was made to obtain the sonogram from the day before. Despite a double-footling breech presentation, the obstetrician elected not to perform a cesarean section. After vaginal delivery, the infant was quadriplegic and had severe hypoxic brain damage.

In suing, the woman claimed her physician was negligent in choice of delivery and that the flexing and rotating of the infant’s head caused a near-complete transection of the spinal cord.

  • The case settled for $11.8 million.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.

Suffolk County (NY) Supreme Court

A third-trimester sonogram showed the fetus in an oblique transverse lie, indicating possible breech presentation, along with hyperextension of the fetus’ spinal cord, indicating the fetus was at high risk for neck injury from a vaginal delivery. The radiologist conveyed the sonogram findings to a nurse, but not the woman’s obstetrician.

The next day the woman began having contractions and went to the emergency room. No attempt was made to obtain the sonogram from the day before. Despite a double-footling breech presentation, the obstetrician elected not to perform a cesarean section. After vaginal delivery, the infant was quadriplegic and had severe hypoxic brain damage.

In suing, the woman claimed her physician was negligent in choice of delivery and that the flexing and rotating of the infant’s head caused a near-complete transection of the spinal cord.

  • The case settled for $11.8 million.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.
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