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Sponge missed, second surgery needed

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St. Louis County (Mo) Circuit Court

Several days after delivering a child by cesarean section, a woman began experiencing severe abdominal pain. Although no abnormality was noted on postoperative x-ray, a surgical sponge was later found in her abdomen, requiring surgical removal.

The woman claimed negligence was committed by the Ob/Gyn for not removing the sponge, the radiologist for not detecting its presence on x-ray, and the hospital team for inaccurately accounting for the sponges prior to surgical closure.

The Ob/Gyn testified that he relied on the surgical team to keep accurate track of the sponges used.

  • The radiologist settled for an undisclosed sum. The jury awarded the plaintiff $175,000, with fault assigned at 20% to the Ob/Gyn, 20% to the radiologist, and 60% to the hospital.
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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St. Louis County (Mo) Circuit Court

Several days after delivering a child by cesarean section, a woman began experiencing severe abdominal pain. Although no abnormality was noted on postoperative x-ray, a surgical sponge was later found in her abdomen, requiring surgical removal.

The woman claimed negligence was committed by the Ob/Gyn for not removing the sponge, the radiologist for not detecting its presence on x-ray, and the hospital team for inaccurately accounting for the sponges prior to surgical closure.

The Ob/Gyn testified that he relied on the surgical team to keep accurate track of the sponges used.

  • The radiologist settled for an undisclosed sum. The jury awarded the plaintiff $175,000, with fault assigned at 20% to the Ob/Gyn, 20% to the radiologist, and 60% to the hospital.
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.

St. Louis County (Mo) Circuit Court

Several days after delivering a child by cesarean section, a woman began experiencing severe abdominal pain. Although no abnormality was noted on postoperative x-ray, a surgical sponge was later found in her abdomen, requiring surgical removal.

The woman claimed negligence was committed by the Ob/Gyn for not removing the sponge, the radiologist for not detecting its presence on x-ray, and the hospital team for inaccurately accounting for the sponges prior to surgical closure.

The Ob/Gyn testified that he relied on the surgical team to keep accurate track of the sponges used.

  • The radiologist settled for an undisclosed sum. The jury awarded the plaintiff $175,000, with fault assigned at 20% to the Ob/Gyn, 20% to the radiologist, and 60% to the hospital.
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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Ob opts for monitoring instead of cerclage

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Ob opts for monitoring instead of cerclage

Undisclosed County (Mass)

A woman at 10 weeks’ gestation presented to an obstetrician in June; her history was significant for diethylstilbestrol exposure, laser conization of the cervix due to noninvasive cervical cancer, a cerclage placed at pregnancy 7 years earlier, and several years of in vitro fertility treatments leading to this conception.

Though her prior obstetrician—now retired—had anticipated a need for cervical cerclage with any future pregnancies, her current doctor opted for frequent monitoring via ultrasound in lieu of cerclage.

Sonograms at 14 and 18 weeks revealed a normal cervix. An ultrasound in late August, however, showed the cervix 1 cm dilated with membranes bulging into the vagina; an emergency cerclage was ordered. The woman was released home and ordered to bed rest.

The woman’s membranes ruptured at 25 weeks’ gestation. At 26 weeks, 3 days, contractions began; the child was delivered via cesarean section. He now suffers from spastic diplegia.

The plaintiff noted that the child’s injuries stemmed from his premature birth.

The Ob/Gyn maintained that the mother’s history did not warrant cerclage placement, and argued that regular monitoring was an appropriate course of action.

  • The case settled for $1.4 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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Undisclosed County (Mass)

A woman at 10 weeks’ gestation presented to an obstetrician in June; her history was significant for diethylstilbestrol exposure, laser conization of the cervix due to noninvasive cervical cancer, a cerclage placed at pregnancy 7 years earlier, and several years of in vitro fertility treatments leading to this conception.

Though her prior obstetrician—now retired—had anticipated a need for cervical cerclage with any future pregnancies, her current doctor opted for frequent monitoring via ultrasound in lieu of cerclage.

Sonograms at 14 and 18 weeks revealed a normal cervix. An ultrasound in late August, however, showed the cervix 1 cm dilated with membranes bulging into the vagina; an emergency cerclage was ordered. The woman was released home and ordered to bed rest.

The woman’s membranes ruptured at 25 weeks’ gestation. At 26 weeks, 3 days, contractions began; the child was delivered via cesarean section. He now suffers from spastic diplegia.

The plaintiff noted that the child’s injuries stemmed from his premature birth.

The Ob/Gyn maintained that the mother’s history did not warrant cerclage placement, and argued that regular monitoring was an appropriate course of action.

  • The case settled for $1.4 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.

Undisclosed County (Mass)

A woman at 10 weeks’ gestation presented to an obstetrician in June; her history was significant for diethylstilbestrol exposure, laser conization of the cervix due to noninvasive cervical cancer, a cerclage placed at pregnancy 7 years earlier, and several years of in vitro fertility treatments leading to this conception.

Though her prior obstetrician—now retired—had anticipated a need for cervical cerclage with any future pregnancies, her current doctor opted for frequent monitoring via ultrasound in lieu of cerclage.

Sonograms at 14 and 18 weeks revealed a normal cervix. An ultrasound in late August, however, showed the cervix 1 cm dilated with membranes bulging into the vagina; an emergency cerclage was ordered. The woman was released home and ordered to bed rest.

The woman’s membranes ruptured at 25 weeks’ gestation. At 26 weeks, 3 days, contractions began; the child was delivered via cesarean section. He now suffers from spastic diplegia.

The plaintiff noted that the child’s injuries stemmed from his premature birth.

The Ob/Gyn maintained that the mother’s history did not warrant cerclage placement, and argued that regular monitoring was an appropriate course of action.

  • The case settled for $1.4 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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Ureter sutured during myomectomy

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<court>Kings County (NY) Supreme Court</court>

Pelvic examination and sonogram on a 40-year-old woman revealed a uterus 20 weeks in size due to multiple fibroids. The woman underwent myomectomy with uterine reconstruction, fulguration of endometriosis, and resection of a right ovarian cyst.

While attempting to remove an irregular calcified fibroid 15 cm in diameter, the physician perforated the patient’s uterine artery, which he repaired before completing the myomectomy and peritoneal and abdominal closure.

Following surgery, the patient experienced decreased urine output; it was discovered her right ureter had been sutured during the procedure. Multiple surgeries were needed to repair the obstruction. Recovery took 6 months, during 2 of which the woman was required to wear a nephrostomy bag.

The patient claimed that the physician conducted inadequate pre- and perioperative testing. Proper testing, she argued, could have prevented the suture injury—or at least alerted the physician to its presence prior to closure, allowing for timely repair.

The physician argued that it was during peritoneal closure—not the uterine artery repair—that the ureter was sutured, and that the woman’s injury was a known risk of this closure. He maintained appropriate testing was conducted.

  • The parties reached a posttrial settlement of $150,000.

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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<court>Kings County (NY) Supreme Court</court>

Pelvic examination and sonogram on a 40-year-old woman revealed a uterus 20 weeks in size due to multiple fibroids. The woman underwent myomectomy with uterine reconstruction, fulguration of endometriosis, and resection of a right ovarian cyst.

While attempting to remove an irregular calcified fibroid 15 cm in diameter, the physician perforated the patient’s uterine artery, which he repaired before completing the myomectomy and peritoneal and abdominal closure.

Following surgery, the patient experienced decreased urine output; it was discovered her right ureter had been sutured during the procedure. Multiple surgeries were needed to repair the obstruction. Recovery took 6 months, during 2 of which the woman was required to wear a nephrostomy bag.

The patient claimed that the physician conducted inadequate pre- and perioperative testing. Proper testing, she argued, could have prevented the suture injury—or at least alerted the physician to its presence prior to closure, allowing for timely repair.

The physician argued that it was during peritoneal closure—not the uterine artery repair—that the ureter was sutured, and that the woman’s injury was a known risk of this closure. He maintained appropriate testing was conducted.

  • The parties reached a posttrial settlement of $150,000.

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.

<court>Kings County (NY) Supreme Court</court>

Pelvic examination and sonogram on a 40-year-old woman revealed a uterus 20 weeks in size due to multiple fibroids. The woman underwent myomectomy with uterine reconstruction, fulguration of endometriosis, and resection of a right ovarian cyst.

While attempting to remove an irregular calcified fibroid 15 cm in diameter, the physician perforated the patient’s uterine artery, which he repaired before completing the myomectomy and peritoneal and abdominal closure.

Following surgery, the patient experienced decreased urine output; it was discovered her right ureter had been sutured during the procedure. Multiple surgeries were needed to repair the obstruction. Recovery took 6 months, during 2 of which the woman was required to wear a nephrostomy bag.

The patient claimed that the physician conducted inadequate pre- and perioperative testing. Proper testing, she argued, could have prevented the suture injury—or at least alerted the physician to its presence prior to closure, allowing for timely repair.

The physician argued that it was during peritoneal closure—not the uterine artery repair—that the ureter was sutured, and that the woman’s injury was a known risk of this closure. He maintained appropriate testing was conducted.

  • The parties reached a posttrial settlement of $150,000.

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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Uterine rupture follows failed VBAC

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Undisclosed County (Calif)

A woman at 41.5 weeks’ gestation was admitted to a hospital for induction of labor after an ultrasound revealed vertex presentation and normal amniotic fluid volume, and a nonstress test was interpreted as nonreactive. The patient had delivered a child by emergency cesarean 4 and a half years earlier; however, she wished to attempt vaginal birth after cesarean (VBAC) for this delivery, and signed a consent form noting the procedure’s risks.

The day following admission, after her membranes spontaneously ruptured and she was fully dilated, the woman began pushing. An hour later, the fetal heart rate dropped suddenly. The doctor began a cesarean delivery approximately 20 minutes later, at which time a uterine rupture was discovered in the lateral fundus. Six minutes after initiation of surgery, the infant was born.

Analysis of cord blood gas revealed severe metabolic acidosis. The newborn was diagnosed with hypoxic-ischemic encephalopathy and required a feeding gastrostomy. He underwent a tracheostomy 6 months later.

In suing, the plaintiffs alleged a negligent delay in both the physician’s recognition of the uterine rupture and the initiation of cesarean delivery.

The defense denied negligence and maintained a timely delivery occurred.

  • The case settled for $3.5 million at 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 County (Calif)

A woman at 41.5 weeks’ gestation was admitted to a hospital for induction of labor after an ultrasound revealed vertex presentation and normal amniotic fluid volume, and a nonstress test was interpreted as nonreactive. The patient had delivered a child by emergency cesarean 4 and a half years earlier; however, she wished to attempt vaginal birth after cesarean (VBAC) for this delivery, and signed a consent form noting the procedure’s risks.

The day following admission, after her membranes spontaneously ruptured and she was fully dilated, the woman began pushing. An hour later, the fetal heart rate dropped suddenly. The doctor began a cesarean delivery approximately 20 minutes later, at which time a uterine rupture was discovered in the lateral fundus. Six minutes after initiation of surgery, the infant was born.

Analysis of cord blood gas revealed severe metabolic acidosis. The newborn was diagnosed with hypoxic-ischemic encephalopathy and required a feeding gastrostomy. He underwent a tracheostomy 6 months later.

In suing, the plaintiffs alleged a negligent delay in both the physician’s recognition of the uterine rupture and the initiation of cesarean delivery.

The defense denied negligence and maintained a timely delivery occurred.

  • The case settled for $3.5 million at 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 County (Calif)

A woman at 41.5 weeks’ gestation was admitted to a hospital for induction of labor after an ultrasound revealed vertex presentation and normal amniotic fluid volume, and a nonstress test was interpreted as nonreactive. The patient had delivered a child by emergency cesarean 4 and a half years earlier; however, she wished to attempt vaginal birth after cesarean (VBAC) for this delivery, and signed a consent form noting the procedure’s risks.

The day following admission, after her membranes spontaneously ruptured and she was fully dilated, the woman began pushing. An hour later, the fetal heart rate dropped suddenly. The doctor began a cesarean delivery approximately 20 minutes later, at which time a uterine rupture was discovered in the lateral fundus. Six minutes after initiation of surgery, the infant was born.

Analysis of cord blood gas revealed severe metabolic acidosis. The newborn was diagnosed with hypoxic-ischemic encephalopathy and required a feeding gastrostomy. He underwent a tracheostomy 6 months later.

In suing, the plaintiffs alleged a negligent delay in both the physician’s recognition of the uterine rupture and the initiation of cesarean delivery.

The defense denied negligence and maintained a timely delivery occurred.

  • The case settled for $3.5 million at 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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Cerebral palsy due to too many embryos?

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<court>Bronx County (NY) Supreme Court</court>

A 29-year-old woman underwent in vitro fertilization and 7 embryos were transferred to her uterus. She became pregnant with triplets and at 5 months developed cervical dilation noted by sonography. She was instructed to cease working. In vitro fertilization. Four days later, the woman presented to the doctor’s office, at which time she was admitted to the hospital.

Four days after admission, the patient went into premature labor. Over the next 6 days she delivered the triplets, all of whom suffered cerebral palsy.

The plaintiffs sued the doctor who performed the implantation, alleging that no more than 2 embryos should have been transferred to the woman’s uterus at 1 time. The transfer of 7 embryos, they argued, was negligent, as this increased the risk of a multigestation pregnancy, which in turn increased the risk of preterm birth. They also sued the physician who reviewed the abnormal ultrasound, arguing that the doctor should have ordered bed rest at that time.

  • The 2 defendant physicians and the defendant hospital settled, agreeing to contribute $14 million into a structured settlement expected to pay more than $100 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>Bronx County (NY) Supreme Court</court>

A 29-year-old woman underwent in vitro fertilization and 7 embryos were transferred to her uterus. She became pregnant with triplets and at 5 months developed cervical dilation noted by sonography. She was instructed to cease working. In vitro fertilization. Four days later, the woman presented to the doctor’s office, at which time she was admitted to the hospital.

Four days after admission, the patient went into premature labor. Over the next 6 days she delivered the triplets, all of whom suffered cerebral palsy.

The plaintiffs sued the doctor who performed the implantation, alleging that no more than 2 embryos should have been transferred to the woman’s uterus at 1 time. The transfer of 7 embryos, they argued, was negligent, as this increased the risk of a multigestation pregnancy, which in turn increased the risk of preterm birth. They also sued the physician who reviewed the abnormal ultrasound, arguing that the doctor should have ordered bed rest at that time.

  • The 2 defendant physicians and the defendant hospital settled, agreeing to contribute $14 million into a structured settlement expected to pay more than $100 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>Bronx County (NY) Supreme Court</court>

A 29-year-old woman underwent in vitro fertilization and 7 embryos were transferred to her uterus. She became pregnant with triplets and at 5 months developed cervical dilation noted by sonography. She was instructed to cease working. In vitro fertilization. Four days later, the woman presented to the doctor’s office, at which time she was admitted to the hospital.

Four days after admission, the patient went into premature labor. Over the next 6 days she delivered the triplets, all of whom suffered cerebral palsy.

The plaintiffs sued the doctor who performed the implantation, alleging that no more than 2 embryos should have been transferred to the woman’s uterus at 1 time. The transfer of 7 embryos, they argued, was negligent, as this increased the risk of a multigestation pregnancy, which in turn increased the risk of preterm birth. They also sued the physician who reviewed the abnormal ultrasound, arguing that the doctor should have ordered bed rest at that time.

  • The 2 defendant physicians and the defendant hospital settled, agreeing to contribute $14 million into a structured settlement expected to pay more than $100 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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Fistula follows vaginal hysterectomy

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<court>Maricopa County (Ariz) Superior Court</court>

After undergoing a vaginal hysterectomy, a 52-year-old woman suffered a rectovaginal fistula. She claimed the physician was negligent for not converting to an abdominal procedure.

The defense argued the fistula stemmed from endometriosis found during surgery, and added that this complication is a known risk of vaginal hysterectomy.

  • 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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<court>Maricopa County (Ariz) Superior Court</court>

After undergoing a vaginal hysterectomy, a 52-year-old woman suffered a rectovaginal fistula. She claimed the physician was negligent for not converting to an abdominal procedure.

The defense argued the fistula stemmed from endometriosis found during surgery, and added that this complication is a known risk of vaginal hysterectomy.

  • 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>Maricopa County (Ariz) Superior Court</court>

After undergoing a vaginal hysterectomy, a 52-year-old woman suffered a rectovaginal fistula. She claimed the physician was negligent for not converting to an abdominal procedure.

The defense argued the fistula stemmed from endometriosis found during surgery, and added that this complication is a known risk of vaginal hysterectomy.

  • 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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Was fetal distress diagnosed too late?

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San Diego County (Calif)

With complaints of mild vaginal bleeding, a 29-year-old woman at 40 weeks’ gestation presented to a medical center, where she underwent 2 nonreactive nonstress tests and an ultrasound examination. The ultrasound examination demonstrated reassuring fetal status and the woman was sent home.

She returned to the medical center in active labor 11 days later, but reported decreased fetal movement.

Fetal monitoring demonstrated late decelerations with absent long-term variability and no accelerations. A scalp-stimulation test, however, indicated adequate fetal response.

Ninety minutes later, profound terminal bradycardia was detected on fetal monitoring, prompting the staff to initiate an emergency cesarean delivery. The child required resuscitation on delivery and demonstrated signs of a seizure disorder. She now suffers from mental retardation and profound physical disability requiring constant care.

In suing, the woman noted that she did not receive instructions on monitoring fetal movement when discharged from her first emergency room visit. Further, she claimed, the diagnosis of fetal distress should have been made earlier, and cesarean delivery initiated sooner.

  • The parties settled for $2.6 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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San Diego County (Calif)

With complaints of mild vaginal bleeding, a 29-year-old woman at 40 weeks’ gestation presented to a medical center, where she underwent 2 nonreactive nonstress tests and an ultrasound examination. The ultrasound examination demonstrated reassuring fetal status and the woman was sent home.

She returned to the medical center in active labor 11 days later, but reported decreased fetal movement.

Fetal monitoring demonstrated late decelerations with absent long-term variability and no accelerations. A scalp-stimulation test, however, indicated adequate fetal response.

Ninety minutes later, profound terminal bradycardia was detected on fetal monitoring, prompting the staff to initiate an emergency cesarean delivery. The child required resuscitation on delivery and demonstrated signs of a seizure disorder. She now suffers from mental retardation and profound physical disability requiring constant care.

In suing, the woman noted that she did not receive instructions on monitoring fetal movement when discharged from her first emergency room visit. Further, she claimed, the diagnosis of fetal distress should have been made earlier, and cesarean delivery initiated sooner.

  • The parties settled for $2.6 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.

San Diego County (Calif)

With complaints of mild vaginal bleeding, a 29-year-old woman at 40 weeks’ gestation presented to a medical center, where she underwent 2 nonreactive nonstress tests and an ultrasound examination. The ultrasound examination demonstrated reassuring fetal status and the woman was sent home.

She returned to the medical center in active labor 11 days later, but reported decreased fetal movement.

Fetal monitoring demonstrated late decelerations with absent long-term variability and no accelerations. A scalp-stimulation test, however, indicated adequate fetal response.

Ninety minutes later, profound terminal bradycardia was detected on fetal monitoring, prompting the staff to initiate an emergency cesarean delivery. The child required resuscitation on delivery and demonstrated signs of a seizure disorder. She now suffers from mental retardation and profound physical disability requiring constant care.

In suing, the woman noted that she did not receive instructions on monitoring fetal movement when discharged from her first emergency room visit. Further, she claimed, the diagnosis of fetal distress should have been made earlier, and cesarean delivery initiated sooner.

  • The parties settled for $2.6 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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Was resident qualified for dystocia delivery?

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Was resident qualified for dystocia delivery?

Kings County (NY) Supreme Court

Following oxytocin administration for induction of labor, a 21-year-old woman at 43 weeks of gestation was brought to the delivery room. The attending physician and a first-year resident were present.

The delivery was complicated by shoulder dystocia. Thus the resident, under supervision of the attending doctor, attempted to dislodge the shoulder using the McRoberts maneuver, suprapubic pressure, and the Woods corkscrew maneuver—none of which she had performed previously for dystocia.

At birth the child had an Apgar score of 9; no fetal injury was noted. Once in the pediatrics unit, however, the infant received a diagnosis of Erb’s palsy. The child now has limited range of motion and contracture of the elbow in the affected arm.

In suing, the plaintiff claimed the attending physician, not the resident, should have delivered the child.

The attending physician maintained the resident was qualified to perform the delivery; she argued that the child’s injuries occurred in utero.

  • The jury awarded the plaintiff $2.2 million, and found the attending physician 95% responsible. The resident physician settled for $250,000.
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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Kings County (NY) Supreme Court

Following oxytocin administration for induction of labor, a 21-year-old woman at 43 weeks of gestation was brought to the delivery room. The attending physician and a first-year resident were present.

The delivery was complicated by shoulder dystocia. Thus the resident, under supervision of the attending doctor, attempted to dislodge the shoulder using the McRoberts maneuver, suprapubic pressure, and the Woods corkscrew maneuver—none of which she had performed previously for dystocia.

At birth the child had an Apgar score of 9; no fetal injury was noted. Once in the pediatrics unit, however, the infant received a diagnosis of Erb’s palsy. The child now has limited range of motion and contracture of the elbow in the affected arm.

In suing, the plaintiff claimed the attending physician, not the resident, should have delivered the child.

The attending physician maintained the resident was qualified to perform the delivery; she argued that the child’s injuries occurred in utero.

  • The jury awarded the plaintiff $2.2 million, and found the attending physician 95% responsible. The resident physician settled for $250,000.
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.

Kings County (NY) Supreme Court

Following oxytocin administration for induction of labor, a 21-year-old woman at 43 weeks of gestation was brought to the delivery room. The attending physician and a first-year resident were present.

The delivery was complicated by shoulder dystocia. Thus the resident, under supervision of the attending doctor, attempted to dislodge the shoulder using the McRoberts maneuver, suprapubic pressure, and the Woods corkscrew maneuver—none of which she had performed previously for dystocia.

At birth the child had an Apgar score of 9; no fetal injury was noted. Once in the pediatrics unit, however, the infant received a diagnosis of Erb’s palsy. The child now has limited range of motion and contracture of the elbow in the affected arm.

In suing, the plaintiff claimed the attending physician, not the resident, should have delivered the child.

The attending physician maintained the resident was qualified to perform the delivery; she argued that the child’s injuries occurred in utero.

  • The jury awarded the plaintiff $2.2 million, and found the attending physician 95% responsible. The resident physician settled for $250,000.
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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Abnormal fundal height: Mishandled?

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Abnormal fundal height: Mishandled?

Undisclosed County (Calif)

A woman at 36.5 weeks’ gestation presented to a clinic for prenatal care. At that time, her fundal height was noted as 31 cm—a 4-cm decline from her previous measurement.

Over the remainder of her pregnancy, her fundal heights were as follows:

  • 31 cm at 37.5 weeks’ gestation—however, a different clinician measured 38 cm at that same visit
  • 32 cm at 39 weeks, 2 days
  • 32 cm at 40 weeks, 2 days (good fetal heart tones and fetal movement were noted)
At 41 weeks, 1 day, the woman presented to the hospital with labor pains. The fetal monitoring strips showed severe variable decelerations and fetal tachycardia with a baseline of 170. A vaginal exam showed 3-cm dilation, 90% effacement, and the fetal vertex at 0 station. The physician ordered internal monitors, amnioinfusion, and terbutaline administration.

Roughly 30 minutes after the drug was given, the child was delivered by cesarean section. He weighed approximately 5 lb and had Apgar scores of 3 and 6. Thick meconium was noted. Two months later, the child was diagnosed with cerebral palsy consistent with hypoxic or ischemic insult.

The plaintiff claimed the defense was negligent in failing to diagnose intrauterine growth retardation.

The defense maintained the standard of care was met at all times.

  • The case settled for $4.1 million at 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 County (Calif)

A woman at 36.5 weeks’ gestation presented to a clinic for prenatal care. At that time, her fundal height was noted as 31 cm—a 4-cm decline from her previous measurement.

Over the remainder of her pregnancy, her fundal heights were as follows:

  • 31 cm at 37.5 weeks’ gestation—however, a different clinician measured 38 cm at that same visit
  • 32 cm at 39 weeks, 2 days
  • 32 cm at 40 weeks, 2 days (good fetal heart tones and fetal movement were noted)
At 41 weeks, 1 day, the woman presented to the hospital with labor pains. The fetal monitoring strips showed severe variable decelerations and fetal tachycardia with a baseline of 170. A vaginal exam showed 3-cm dilation, 90% effacement, and the fetal vertex at 0 station. The physician ordered internal monitors, amnioinfusion, and terbutaline administration.

Roughly 30 minutes after the drug was given, the child was delivered by cesarean section. He weighed approximately 5 lb and had Apgar scores of 3 and 6. Thick meconium was noted. Two months later, the child was diagnosed with cerebral palsy consistent with hypoxic or ischemic insult.

The plaintiff claimed the defense was negligent in failing to diagnose intrauterine growth retardation.

The defense maintained the standard of care was met at all times.

  • The case settled for $4.1 million at 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 County (Calif)

A woman at 36.5 weeks’ gestation presented to a clinic for prenatal care. At that time, her fundal height was noted as 31 cm—a 4-cm decline from her previous measurement.

Over the remainder of her pregnancy, her fundal heights were as follows:

  • 31 cm at 37.5 weeks’ gestation—however, a different clinician measured 38 cm at that same visit
  • 32 cm at 39 weeks, 2 days
  • 32 cm at 40 weeks, 2 days (good fetal heart tones and fetal movement were noted)
At 41 weeks, 1 day, the woman presented to the hospital with labor pains. The fetal monitoring strips showed severe variable decelerations and fetal tachycardia with a baseline of 170. A vaginal exam showed 3-cm dilation, 90% effacement, and the fetal vertex at 0 station. The physician ordered internal monitors, amnioinfusion, and terbutaline administration.

Roughly 30 minutes after the drug was given, the child was delivered by cesarean section. He weighed approximately 5 lb and had Apgar scores of 3 and 6. Thick meconium was noted. Two months later, the child was diagnosed with cerebral palsy consistent with hypoxic or ischemic insult.

The plaintiff claimed the defense was negligent in failing to diagnose intrauterine growth retardation.

The defense maintained the standard of care was met at all times.

  • The case settled for $4.1 million at 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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Inability to void follows laparoscopy

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Inability to void follows laparoscopy

Suffolk County (NY) Supreme Court

Following laparoscopy to treat endometriosis, a 32-year-old woman was unable to void spontaneously. Nevertheless, her gynecologists approved her discharge and the patient returned home.

The following day, the woman presented to the emergency room, noting a continued inability to void. Hospital staff removed 1,000 mL of urine via catheterization, but her retention was never resolved. She remains unable to void and thus requires catheterization.

In suing, the woman claimed bladder distention caused muscle damage leading to urinary retention. She also noted that the physician ordered her hospital discharge without providing clear instructions regarding her voiding difficulties.

The defendant argued the woman’s problem was likely neurologic and unrelated to his care.

  • 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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Suffolk County (NY) Supreme Court

Following laparoscopy to treat endometriosis, a 32-year-old woman was unable to void spontaneously. Nevertheless, her gynecologists approved her discharge and the patient returned home.

The following day, the woman presented to the emergency room, noting a continued inability to void. Hospital staff removed 1,000 mL of urine via catheterization, but her retention was never resolved. She remains unable to void and thus requires catheterization.

In suing, the woman claimed bladder distention caused muscle damage leading to urinary retention. She also noted that the physician ordered her hospital discharge without providing clear instructions regarding her voiding difficulties.

The defendant argued the woman’s problem was likely neurologic and unrelated to his care.

  • 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.

Suffolk County (NY) Supreme Court

Following laparoscopy to treat endometriosis, a 32-year-old woman was unable to void spontaneously. Nevertheless, her gynecologists approved her discharge and the patient returned home.

The following day, the woman presented to the emergency room, noting a continued inability to void. Hospital staff removed 1,000 mL of urine via catheterization, but her retention was never resolved. She remains unable to void and thus requires catheterization.

In suing, the woman claimed bladder distention caused muscle damage leading to urinary retention. She also noted that the physician ordered her hospital discharge without providing clear instructions regarding her voiding difficulties.

The defendant argued the woman’s problem was likely neurologic and unrelated to his care.

  • 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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