Fecal incontinence due to prolonged delivery?
<court>New York County (NY) Supreme Court</court>
When delivery had not occurred after 3 hours of stage 2 labor, a 30-year-old woman under the care of a certified nurse midwife was transferred from a childbirth facility to a hospital. The obstetrician opted to proceed with vaginal delivery, and ordered an epidural and oxytocin.
After 6 hours of second-stage labor, the physician instructed a second-year resident to apply fundal pressure. Half an hour later, following a midline episiotomy, the midwife delivered an 8-lb, 14-oz child. A 4th-degree perineal tear was identified and repaired by the resident physician.
Several weeks after the delivery, the woman noted symptoms of fecal incontinence. Despite conservative management and 3 surgical interventions, the woman’s condition persists.
In suing, the patient claimed that the obstetrician should have ordered a cesarean delivery immediately upon her presentation at the hospital. She claimed that vaginal delivery was inappropriate after a 6.5-hour second stage of labor, and alleged that oxytocin and fundal pressure were contraindicated. Finally, she claimed the episiotomy was improperly performed.
The defense denied negligence, noting that the woman’s injury is a known risk of a properly performed episiotomy and repair. Further, they noted that use of fundal pressure and oxytocin led to the delivery of a healthy infant.
- 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.