Preterm labor: Missed or not present?
<court>Cook County (Ill) Circuit Court</court>
Due to complaints of “kicking” and shooting back pain, a 44-year-old woman at 25 weeks’ gestation was ordered to the hospital by her obstetrician, for evaluation for preterm labor. A nurse conducted the exam from the physician’s telephone instructions.
Both palpation and examination via external monitoring revealed no signs of contractions, and the nurse observed that the woman’s cervix was closed. When the patient noted continued pain, the physician ordered 3 doses of terbutaline. The woman later reported her symptoms had resolved, and was released 3 hours later with instructions to call if she felt pain or kicking more than 4 times per hour.
The woman was previously scheduled for a prenatal visit 9 hours later. Upon presenting for that appointment, she reported 3 to 4 brief contractions in the intervening hours. Examination revealed cervical dilation of 2 to 3 cm with a bulging bag. She was transferred to the hospital, but did not experience any contractions during transport. Upon arrival at the hospital, her cervix was to 3 to 4 cm dilated. The child was delivered via cesarean section 2 hours later.
The child suffered cerebral palsy and spastic quadriplegia and required a tracheostomy tube. He is currently confined to a wheelchair.
The plaintiff sued the hospital, the medical group, and the obstetrician, claiming negligence for failing to properly treat preterm labor.
The defendants maintained that the woman was not experiencing preterm labor at her initial visit. Instead, they argued that an incompetent cervix aggravated by chorioamnionitis led to the preterm labor, and claimed that the outcome could not have been prevented.
- The hospital settled for $600,000 prior to trial. The jury returned a defense verdict for the obstetrician and the medical group.
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.