Did low amniotic fluid cause cerebral palsy?
A BICORNUATE UTERUS and the infant’s breech position complicated a woman’s pregnancy. At her 39-week prenatal visit, testing showed a low amniotic fluid level, but the woman was sent home. Two days later, she went to the hospital in labor. Her ObGyn first allowed labor to proceed, then performed a cesarean delivery. The father recorded the birth on video camera. The baby was born “essentially lifeless” but with a weak heartbeat. The child was diagnosed with cerebral palsy.
PATIENT’S CLAIM A cesarean delivery should have been performed as soon as it was determined that the amniotic fluid level was low. During surgery, the ObGyn did not choose an incision location that would deliver the baby quickly. The recording evidenced that there was a delay in delivery.
PHYSICIAN’S DEFENSE Elective cesarean delivery was not necessary at the time of the patient’s last visit, as one is not performed before 40 weeks’ gestation. Cesarean delivery was appropriately performed. The baby had a good heart rate at birth. Brain damage was due to fetal inflammatory response syndrome.
VERDICT A $58 million Connecticut verdict was returned.
Death from meningitis after miscarriage
COMPLAINING OF VAGINAL BLEEDING, a woman in her 20s went to an emergency department. She was found to be about 12 weeks’ pregnant. An ObGyn diagnosed spontaneous abortion/miscarriage. Ultrasonography showed that fetal tissue had been expelled, and that no products of conception remained, only blood clots. The woman was given the option of 1) dilatation and curettage (D&C) or 2) letting the residual material expel without intervention. She chose the latter, and was discharged with instructions to return if her condition became worse. Three days later, the woman was admitted to another hospital with Group B streptococcal meningitis and a urinary tract infection. She died 2 days later.
ESTATE’S CLAIM A D&C should have been performed. Prophylactic antibiotics should have been prescribed, which would have stopped the infectious process and allowed the decedent to survive.
DEFENDANTS’ DEFENSE Prophylactic antibiotics were unnecessary because there were no signs or symptoms of infection when the woman was discharged. Prophylactic antibiotics would not have appropriately treated meningitis, and could have made the infection progress more rapidly by destroying the body’s infection-fighting process. There was no need for a D&C because ultrasonography identified no retained products of conception—indicating that there were no foreign substances to cause an infection.
VERDICT A Maryland defense verdict was returned.
Reduced fetal movement and severe brain damage
AT HER 39-WEEK PRENATAL VISIT, a woman reported that the baby wasn’t as active as usual. She was seen by a resident, who did not apply a fetal heart monitor or have the attending ObGyn examine the mother. She was sent home. Two days later, the mother realized the baby was not moving at all, and returned to the clinic. Emergency cesarean delivery was performed. The child has severe brain damage and cerebral palsy.
PATIENT’S CLAIM The resident failed to appropriately respond when the mother reported the baby was not active. The attending ObGyn should have been called, and the baby’s heart rate should have been monitored. It was later found that a clotting abnormality had developed, causing an inadequate supply of oxygen to the fetal brain. Proper response to the report of decreased movement would have resulted in the delivery of a healthy child.
PHYSICIANS’ DEFENSE Brain damage occurred prior to the mother’s 39th-week visit. This was apparent because of the child’s joint contractures, which, the defense argued, take a week or longer to develop. (The plaintiff countered that contractures were mild and that the infant was moving his arms and legs a short time after delivery.)
VERDICT A $4,821,000 Missouri verdict was returned.
Scalpel breaks during robotic surgery
ROBOT-ASSISTED LAPAROSCOPIC pelvic mass resection was performed on an obese 47-year-old woman. During surgery, the lower blade of an ultrasonic, vibrating scalpel dislodged. Dr. A spent 90 minutes searching for the blade, which he eventually found. The mass was removed and diagnosed as benign. During recovery, the patient became septic, went into acute renal failure, acute respiratory failure, and septic shock. A diagnosis of fecal peritonitis was made.
Dr. B assumed the care of the patient, and later found a colon perforation. Four days after the initial procedure, the patient underwent a colon resection. She was initially treated with a colostomy and then had a successful bowel reanastomosis 7 months after the injury.
PATIENT’S CLAIM Dr. A was negligent in applying too much pressure, dislodging the blade. Dr. A was also faulty in his search for the blade, which was the cause of bowel perforation. Both Drs. A and B were negligent in failing to discover the injury earlier.