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Cesarean declined, stillbirth follows
Two weeks past her due date and 12 hours before a scheduled induction, a woman with a prior cesarean presented to a hospital reporting decreased fetal movement.
On fetal monitoring, the child’s heart rate was nonreactive with decreased variability. When examination showed the woman’s cervix was closed, the obstetrician offered a cesarean section. The woman refused, opting for a trial of labor. A cervical ripening agent was administered via suppository.
When, 5 hours later, fetal monitoring showed 2 late decelerations but the cervix remained undilated, the physician once again offered a cesarean. The woman again declined.
An epidural was administered 2.5 hours later, after which the child’s heart rate dropped sharply. Sonography soon after revealed no fetal heart rate. An emergency cesarean was performed, but the child was stillborn.
The woman sued, claiming a cesarean should have been performed after the first signs of fetal distress. Had delivery occurred any time prior to the 2 late decelerations, she alleged, the child would have been born alive.
The defendant noted that the woman twice declined a cesarean section.
- The case settled for $375,000.
Two weeks past her due date and 12 hours before a scheduled induction, a woman with a prior cesarean presented to a hospital reporting decreased fetal movement.
On fetal monitoring, the child’s heart rate was nonreactive with decreased variability. When examination showed the woman’s cervix was closed, the obstetrician offered a cesarean section. The woman refused, opting for a trial of labor. A cervical ripening agent was administered via suppository.
When, 5 hours later, fetal monitoring showed 2 late decelerations but the cervix remained undilated, the physician once again offered a cesarean. The woman again declined.
An epidural was administered 2.5 hours later, after which the child’s heart rate dropped sharply. Sonography soon after revealed no fetal heart rate. An emergency cesarean was performed, but the child was stillborn.
The woman sued, claiming a cesarean should have been performed after the first signs of fetal distress. Had delivery occurred any time prior to the 2 late decelerations, she alleged, the child would have been born alive.
The defendant noted that the woman twice declined a cesarean section.
- The case settled for $375,000.
Two weeks past her due date and 12 hours before a scheduled induction, a woman with a prior cesarean presented to a hospital reporting decreased fetal movement.
On fetal monitoring, the child’s heart rate was nonreactive with decreased variability. When examination showed the woman’s cervix was closed, the obstetrician offered a cesarean section. The woman refused, opting for a trial of labor. A cervical ripening agent was administered via suppository.
When, 5 hours later, fetal monitoring showed 2 late decelerations but the cervix remained undilated, the physician once again offered a cesarean. The woman again declined.
An epidural was administered 2.5 hours later, after which the child’s heart rate dropped sharply. Sonography soon after revealed no fetal heart rate. An emergency cesarean was performed, but the child was stillborn.
The woman sued, claiming a cesarean should have been performed after the first signs of fetal distress. Had delivery occurred any time prior to the 2 late decelerations, she alleged, the child would have been born alive.
The defendant noted that the woman twice declined a cesarean section.
- The case settled for $375,000.
Excessive force used on fetal head?
A woman experienced a normal pregnancy and an uneventful labor through delivery of the fetal head, at which time shoulder dystocia was encountered.
Delivery notes indicate that the obstetrician used suprapubic pressure, the McRoberts maneuver, and minimal traction on the fetal head to dislodge the shoulder. The child, 8 lb 9 oz at birth, was noted to have bruising to his head and scalp, a molded head, and limited movement of his left arm and hand. He was diagnosed with Erb’s palsy, and claims to have permanent damage to his left biceps, left triceps, and middle deltoid, despite 3 surgeries and extensive physical therapy.
In suing, the child claimed that the defendant used excessive force when pulling on his head during delivery.
The obstetrician admitted she had pulled continuously on the fetal head for 20 to 30 seconds, and did not know how much force she used.
She claimed, however, that it was impossible to determine the cause of the child’s injury, which may have occurred prior to delivery. Further, she noted the injury was minor and did not greatly impede the plaintiff’s quality of life.
- The jury awarded the plaintiff $1.8 million.
A woman experienced a normal pregnancy and an uneventful labor through delivery of the fetal head, at which time shoulder dystocia was encountered.
Delivery notes indicate that the obstetrician used suprapubic pressure, the McRoberts maneuver, and minimal traction on the fetal head to dislodge the shoulder. The child, 8 lb 9 oz at birth, was noted to have bruising to his head and scalp, a molded head, and limited movement of his left arm and hand. He was diagnosed with Erb’s palsy, and claims to have permanent damage to his left biceps, left triceps, and middle deltoid, despite 3 surgeries and extensive physical therapy.
In suing, the child claimed that the defendant used excessive force when pulling on his head during delivery.
The obstetrician admitted she had pulled continuously on the fetal head for 20 to 30 seconds, and did not know how much force she used.
She claimed, however, that it was impossible to determine the cause of the child’s injury, which may have occurred prior to delivery. Further, she noted the injury was minor and did not greatly impede the plaintiff’s quality of life.
- The jury awarded the plaintiff $1.8 million.
A woman experienced a normal pregnancy and an uneventful labor through delivery of the fetal head, at which time shoulder dystocia was encountered.
Delivery notes indicate that the obstetrician used suprapubic pressure, the McRoberts maneuver, and minimal traction on the fetal head to dislodge the shoulder. The child, 8 lb 9 oz at birth, was noted to have bruising to his head and scalp, a molded head, and limited movement of his left arm and hand. He was diagnosed with Erb’s palsy, and claims to have permanent damage to his left biceps, left triceps, and middle deltoid, despite 3 surgeries and extensive physical therapy.
In suing, the child claimed that the defendant used excessive force when pulling on his head during delivery.
The obstetrician admitted she had pulled continuously on the fetal head for 20 to 30 seconds, and did not know how much force she used.
She claimed, however, that it was impossible to determine the cause of the child’s injury, which may have occurred prior to delivery. Further, she noted the injury was minor and did not greatly impede the plaintiff’s quality of life.
- The jury awarded the plaintiff $1.8 million.
Hysterectomy defies patient’s wish
A 47-year-old woman with a strong belief in holistic medicine presented to an Ob/Gyn with abdominal complaints. Suspecting ovarian cysts, the physician scheduled an exploratory procedure.
Prior to surgery, the woman expressly stated in writing that a hysterectomy was not to be performed, since this procedure went against her beliefs. At surgery, however, the physician encountered excessive bleeding and performed an abdominal hysterectomy.
In suing, the woman noted that the physician had defied her wishes, and claimed the hysterectomy caused her emotional distress.
The defendant maintained that his decision was appropriate given the bleeding he discovered.
- The parties settled for $210,000.
A 47-year-old woman with a strong belief in holistic medicine presented to an Ob/Gyn with abdominal complaints. Suspecting ovarian cysts, the physician scheduled an exploratory procedure.
Prior to surgery, the woman expressly stated in writing that a hysterectomy was not to be performed, since this procedure went against her beliefs. At surgery, however, the physician encountered excessive bleeding and performed an abdominal hysterectomy.
In suing, the woman noted that the physician had defied her wishes, and claimed the hysterectomy caused her emotional distress.
The defendant maintained that his decision was appropriate given the bleeding he discovered.
- The parties settled for $210,000.
A 47-year-old woman with a strong belief in holistic medicine presented to an Ob/Gyn with abdominal complaints. Suspecting ovarian cysts, the physician scheduled an exploratory procedure.
Prior to surgery, the woman expressly stated in writing that a hysterectomy was not to be performed, since this procedure went against her beliefs. At surgery, however, the physician encountered excessive bleeding and performed an abdominal hysterectomy.
In suing, the woman noted that the physician had defied her wishes, and claimed the hysterectomy caused her emotional distress.
The defendant maintained that his decision was appropriate given the bleeding he discovered.
- The parties settled for $210,000.
Was viable pregnancy negligently terminated?
A 28-year-old woman presented to an Ob/Gyn reporting several days of vaginal spotting after a positive pregnancy test. No intrauterine pregnancy could be found on transvaginal ultrasound. Suspecting an ectopic pregnancy, the physician advised termination.
The plaintiff agreed, but later sued the doctor, alleging the pregnancy was actually intrauterine. She further claimed lack of informed consent and an inability to become pregnant.
The defendant maintained that the diagnosis was accurate, and noted that termination was necessary, since the condition’s consequences can be fatal. He also claimed informed consent was granted, and noted that the termination offered the woman the greatest chance of future fertility.
- The jury returned a defense verdict.
A 28-year-old woman presented to an Ob/Gyn reporting several days of vaginal spotting after a positive pregnancy test. No intrauterine pregnancy could be found on transvaginal ultrasound. Suspecting an ectopic pregnancy, the physician advised termination.
The plaintiff agreed, but later sued the doctor, alleging the pregnancy was actually intrauterine. She further claimed lack of informed consent and an inability to become pregnant.
The defendant maintained that the diagnosis was accurate, and noted that termination was necessary, since the condition’s consequences can be fatal. He also claimed informed consent was granted, and noted that the termination offered the woman the greatest chance of future fertility.
- The jury returned a defense verdict.
A 28-year-old woman presented to an Ob/Gyn reporting several days of vaginal spotting after a positive pregnancy test. No intrauterine pregnancy could be found on transvaginal ultrasound. Suspecting an ectopic pregnancy, the physician advised termination.
The plaintiff agreed, but later sued the doctor, alleging the pregnancy was actually intrauterine. She further claimed lack of informed consent and an inability to become pregnant.
The defendant maintained that the diagnosis was accurate, and noted that termination was necessary, since the condition’s consequences can be fatal. He also claimed informed consent was granted, and noted that the termination offered the woman the greatest chance of future fertility.
- The jury returned a defense verdict.
Covering physician encounters dystocia
<court>Essex County (NJ) Superior Court</court>
An Ob/Gyn, filling in for a vacationing obstetrician, induced labor in a woman at 36 weeks’ gestation with gestational diabetes and ruptured membranes.
Despite signs of fetal distress, the defendant opted for a forceps delivery. The child suffered Erb’s palsy, which required 3 surgeries by the time of trial.
In suing, the plaintiff argued that the defendant did not review the woman’s medical records. Had he done so, he would have learned that a prior sonogram showed a disproportionally large torso (stemming from the mother’s gestational diabetes), which would have alerted him that a cesarean delivery might be necessary.
- The jury returned a verdict for the plaintiff in the amount of $2.3 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>Essex County (NJ) Superior Court</court>
An Ob/Gyn, filling in for a vacationing obstetrician, induced labor in a woman at 36 weeks’ gestation with gestational diabetes and ruptured membranes.
Despite signs of fetal distress, the defendant opted for a forceps delivery. The child suffered Erb’s palsy, which required 3 surgeries by the time of trial.
In suing, the plaintiff argued that the defendant did not review the woman’s medical records. Had he done so, he would have learned that a prior sonogram showed a disproportionally large torso (stemming from the mother’s gestational diabetes), which would have alerted him that a cesarean delivery might be necessary.
- The jury returned a verdict for the plaintiff in the amount of $2.3 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>Essex County (NJ) Superior Court</court>
An Ob/Gyn, filling in for a vacationing obstetrician, induced labor in a woman at 36 weeks’ gestation with gestational diabetes and ruptured membranes.
Despite signs of fetal distress, the defendant opted for a forceps delivery. The child suffered Erb’s palsy, which required 3 surgeries by the time of trial.
In suing, the plaintiff argued that the defendant did not review the woman’s medical records. Had he done so, he would have learned that a prior sonogram showed a disproportionally large torso (stemming from the mother’s gestational diabetes), which would have alerted him that a cesarean delivery might be necessary.
- The jury returned a verdict for the plaintiff in the amount of $2.3 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.
McRoberts maneuver not recorded
Following a delivery complicated by shoulder dystocia, a child was diagnosed with Erb’s palsy. In suing, the plaintiffs argued the obstetrician did not employ proper maneuvers to dislodge the shoulder.
The defendant claimed that the McRoberts maneuver was used, but never recorded on the chart. Further, it was argued that labor progressed quickly after the dystocia was recognized.
- The jury awarded the plaintiffs $750,000.
Following a delivery complicated by shoulder dystocia, a child was diagnosed with Erb’s palsy. In suing, the plaintiffs argued the obstetrician did not employ proper maneuvers to dislodge the shoulder.
The defendant claimed that the McRoberts maneuver was used, but never recorded on the chart. Further, it was argued that labor progressed quickly after the dystocia was recognized.
- The jury awarded the plaintiffs $750,000.
Following a delivery complicated by shoulder dystocia, a child was diagnosed with Erb’s palsy. In suing, the plaintiffs argued the obstetrician did not employ proper maneuvers to dislodge the shoulder.
The defendant claimed that the McRoberts maneuver was used, but never recorded on the chart. Further, it was argued that labor progressed quickly after the dystocia was recognized.
- The jury awarded the plaintiffs $750,000.
Cesarean ordered late, no OR available
Approximately 1 half-hour after admission, fetal monitoring of a woman presenting with ruptured membranes revealed 2 periods of brief deceleration. In the half-hour that followed, however, no decelerations were reported.
The obstetrician left to see other patients, and instructed the nurse to continue fetal monitoring and report any changes. Several periods of decelerations followed, but the nurse never informed the physician. Instead, approximately 1 hour after the first of these decelerations, she reported to the doctor that both mother and fetus were fine.
Following this conversation, the child’s heart rate again dropped, at one point reaching 39 beats per minute. A new nurse contacted the doctor, noting the woman was 8 cm dilated but never conveying the extent of the decelerations.
An emergency cesarean was ordered, but 34 minutes passed before an operating room was available. The child was born with an Apgar score of 0, but was resuscitated. He suffers brain damage and cerebral palsy, and is unable to walk or talk.
In suing, the plaintiff argued that nurses were negligent for not notifying the obstetrician of the heart-rate decelerations promptly. Had this information been conveyed, it was argued, cesarean delivery would have occurred sooner. The plaintiff further cited the hospital for negligence for failing to have an operating room available.
The defendants argued the child’s condition stemmed from a ruptured umbilical cord.
- The obstetrician settled for $450,000 during trial. The jury awarded the plaintiff $23.3 million against the hospital.
Approximately 1 half-hour after admission, fetal monitoring of a woman presenting with ruptured membranes revealed 2 periods of brief deceleration. In the half-hour that followed, however, no decelerations were reported.
The obstetrician left to see other patients, and instructed the nurse to continue fetal monitoring and report any changes. Several periods of decelerations followed, but the nurse never informed the physician. Instead, approximately 1 hour after the first of these decelerations, she reported to the doctor that both mother and fetus were fine.
Following this conversation, the child’s heart rate again dropped, at one point reaching 39 beats per minute. A new nurse contacted the doctor, noting the woman was 8 cm dilated but never conveying the extent of the decelerations.
An emergency cesarean was ordered, but 34 minutes passed before an operating room was available. The child was born with an Apgar score of 0, but was resuscitated. He suffers brain damage and cerebral palsy, and is unable to walk or talk.
In suing, the plaintiff argued that nurses were negligent for not notifying the obstetrician of the heart-rate decelerations promptly. Had this information been conveyed, it was argued, cesarean delivery would have occurred sooner. The plaintiff further cited the hospital for negligence for failing to have an operating room available.
The defendants argued the child’s condition stemmed from a ruptured umbilical cord.
- The obstetrician settled for $450,000 during trial. The jury awarded the plaintiff $23.3 million against the hospital.
Approximately 1 half-hour after admission, fetal monitoring of a woman presenting with ruptured membranes revealed 2 periods of brief deceleration. In the half-hour that followed, however, no decelerations were reported.
The obstetrician left to see other patients, and instructed the nurse to continue fetal monitoring and report any changes. Several periods of decelerations followed, but the nurse never informed the physician. Instead, approximately 1 hour after the first of these decelerations, she reported to the doctor that both mother and fetus were fine.
Following this conversation, the child’s heart rate again dropped, at one point reaching 39 beats per minute. A new nurse contacted the doctor, noting the woman was 8 cm dilated but never conveying the extent of the decelerations.
An emergency cesarean was ordered, but 34 minutes passed before an operating room was available. The child was born with an Apgar score of 0, but was resuscitated. He suffers brain damage and cerebral palsy, and is unable to walk or talk.
In suing, the plaintiff argued that nurses were negligent for not notifying the obstetrician of the heart-rate decelerations promptly. Had this information been conveyed, it was argued, cesarean delivery would have occurred sooner. The plaintiff further cited the hospital for negligence for failing to have an operating room available.
The defendants argued the child’s condition stemmed from a ruptured umbilical cord.
- The obstetrician settled for $450,000 during trial. The jury awarded the plaintiff $23.3 million against the hospital.
Did negligence lead to ureter, colon injury?
<court>Lucas County (Ohio) Common Pleas Court</court>
Following a laparoscopic bilateral salpingo-oophorectomy in a 53-year-old woman with chronic pelvic pain, a pyelogram revealed an injured ureter. The injury was repaired and the patient discharged.
The woman returned to the hospital a week and a half later, at which time it was discovered that her sigmoid colon had also been injured in the first surgery, leading to a fistula. She was treated with a colostomy, and 6 months later the bowel was reanastomosed.
In suing, the woman claimed the physician was negligent for injuring her ureter and colon, and failing to detect the damage in a timely fashion. Had the injury been promptly identified, she argued, her complications would have been less severe.
The defendant denied negligence, noting that ureter injury is a known complication of salpingo-oophorectomy. He further claimed that the damage subsequently discovered developed as a complication of the ureter injury, which was detected and repaired promptly after surgery.
- 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.
<court>Lucas County (Ohio) Common Pleas Court</court>
Following a laparoscopic bilateral salpingo-oophorectomy in a 53-year-old woman with chronic pelvic pain, a pyelogram revealed an injured ureter. The injury was repaired and the patient discharged.
The woman returned to the hospital a week and a half later, at which time it was discovered that her sigmoid colon had also been injured in the first surgery, leading to a fistula. She was treated with a colostomy, and 6 months later the bowel was reanastomosed.
In suing, the woman claimed the physician was negligent for injuring her ureter and colon, and failing to detect the damage in a timely fashion. Had the injury been promptly identified, she argued, her complications would have been less severe.
The defendant denied negligence, noting that ureter injury is a known complication of salpingo-oophorectomy. He further claimed that the damage subsequently discovered developed as a complication of the ureter injury, which was detected and repaired promptly after surgery.
- 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.
<court>Lucas County (Ohio) Common Pleas Court</court>
Following a laparoscopic bilateral salpingo-oophorectomy in a 53-year-old woman with chronic pelvic pain, a pyelogram revealed an injured ureter. The injury was repaired and the patient discharged.
The woman returned to the hospital a week and a half later, at which time it was discovered that her sigmoid colon had also been injured in the first surgery, leading to a fistula. She was treated with a colostomy, and 6 months later the bowel was reanastomosed.
In suing, the woman claimed the physician was negligent for injuring her ureter and colon, and failing to detect the damage in a timely fashion. Had the injury been promptly identified, she argued, her complications would have been less severe.
The defendant denied negligence, noting that ureter injury is a known complication of salpingo-oophorectomy. He further claimed that the damage subsequently discovered developed as a complication of the ureter injury, which was detected and repaired promptly after surgery.
- 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.
Did bowel injury lead to finger amputation?
Following a hysterectomy, a 46-year-old woman suffered multiple complications, requiring 112 days of hospitalization and 6 subsequent surgeries—including amputation of her left thumb and index finger.
In suing, the woman claimed the Ob/Gyn injured her bowel during surgery; this injury went undetected, which led to infection and, ultimately, gangrene in her left hand and septic shock. In addition to the amputation, she also required a tracheostomy and a colostomy for almost a full year. Also cited in the suit were the hospital and several surgical consultants.
The defendant maintained that the woman’s complications were due not to bowel injury, but rather to an unavoidable vaginal cuff infection.
- The hospital and consulting surgeons settled for an undisclosed amount. The jury returned a plaintiff verdict, finding the Ob/Gyn 70% at fault. A gross verdict of $6.6 million was reduced to $5.3 million for appointment of fault.
Following a hysterectomy, a 46-year-old woman suffered multiple complications, requiring 112 days of hospitalization and 6 subsequent surgeries—including amputation of her left thumb and index finger.
In suing, the woman claimed the Ob/Gyn injured her bowel during surgery; this injury went undetected, which led to infection and, ultimately, gangrene in her left hand and septic shock. In addition to the amputation, she also required a tracheostomy and a colostomy for almost a full year. Also cited in the suit were the hospital and several surgical consultants.
The defendant maintained that the woman’s complications were due not to bowel injury, but rather to an unavoidable vaginal cuff infection.
- The hospital and consulting surgeons settled for an undisclosed amount. The jury returned a plaintiff verdict, finding the Ob/Gyn 70% at fault. A gross verdict of $6.6 million was reduced to $5.3 million for appointment of fault.
Following a hysterectomy, a 46-year-old woman suffered multiple complications, requiring 112 days of hospitalization and 6 subsequent surgeries—including amputation of her left thumb and index finger.
In suing, the woman claimed the Ob/Gyn injured her bowel during surgery; this injury went undetected, which led to infection and, ultimately, gangrene in her left hand and septic shock. In addition to the amputation, she also required a tracheostomy and a colostomy for almost a full year. Also cited in the suit were the hospital and several surgical consultants.
The defendant maintained that the woman’s complications were due not to bowel injury, but rather to an unavoidable vaginal cuff infection.
- The hospital and consulting surgeons settled for an undisclosed amount. The jury returned a plaintiff verdict, finding the Ob/Gyn 70% at fault. A gross verdict of $6.6 million was reduced to $5.3 million for appointment of fault.
Did flawed clamping lead to cerebral palsy?
A woman delivered an infant girl, who soon after birth went into hypovolemic shock. She was immediately brought to intensive care, but now suffers cerebral palsy, quadriparesis, and mental retardation.
The plaintiff claimed physicians did not adequately clamp the umbilical cord before it was cut; this led to bleeding from the cord and, ultimately, the hypovolemia that caused her current condition.
The defense contended bleeding at birth was minimal and the child’s injuries stemmed from an intrauterine condition.
- The case settled for $4.8 million.
A woman delivered an infant girl, who soon after birth went into hypovolemic shock. She was immediately brought to intensive care, but now suffers cerebral palsy, quadriparesis, and mental retardation.
The plaintiff claimed physicians did not adequately clamp the umbilical cord before it was cut; this led to bleeding from the cord and, ultimately, the hypovolemia that caused her current condition.
The defense contended bleeding at birth was minimal and the child’s injuries stemmed from an intrauterine condition.
- The case settled for $4.8 million.
A woman delivered an infant girl, who soon after birth went into hypovolemic shock. She was immediately brought to intensive care, but now suffers cerebral palsy, quadriparesis, and mental retardation.
The plaintiff claimed physicians did not adequately clamp the umbilical cord before it was cut; this led to bleeding from the cord and, ultimately, the hypovolemia that caused her current condition.
The defense contended bleeding at birth was minimal and the child’s injuries stemmed from an intrauterine condition.
- The case settled for $4.8 million.