Head entrapment in premature baby
DURING BREECH VAGINAL DELIVERY of a premature infant, the child’s head became entrapped. A maternal-fetal medicine specialist was called in. Delivery took 22 minutes. The child has cerebral palsy, with severe developmental delays, and requires a gastrostomy tube and tracheotomy.
PATIENT’S CLAIM Lack of oxygen for 22 minutes before delivery caused brain damage. Inappropriate maneuvers used by the physicians and nurses to relieve head entrapment also contributed to the injury. An emergency cesarean delivery should have been performed when vaginal delivery was delayed.
DEFENDANTS’ DEFENSE The appropriate maneuvers were performed to release the entrapped head. The child’s problems were due to her prematurity and fetal inflammatory response syndrome.
VERDICT In Illinois, a summary judgment was granted for the maternal-fetal medicine physician. A directed verdict was given for one nurse. A jury returned a defense verdict for the hospital, a labor and delivery nurse, and one of the ObGyns. The jury deadlocked on the claims against a second ObGyn.
Stenotic os thwarts two biopsies
AT HER ANNUAL VISIT in June 2006, a 48-year-old woman reported heavy bleeding. Her ObGyn asked the woman to return for re-examination. Twelve days later, ultrasonography revealed an enlarged uterus. The ObGyn attempted to perform a biopsy, but failed because of a stenotic os.
In September 2006, after a course of hormones, the ObGyn again tried to obtain a biopsy, but once more encountered the stenotic os. A hysterectomy was discussed, but the patient declined. In October 2007, the woman agreed to a hysterectomy. During surgery, the ObGyn identified cancer, and a gynecologic oncologist was called in. The woman was found to have stage-IV endometrial cancer. She underwent chemotherapy; at trial, the cancer was in remission.
PATIENT’S CLAIM Cancer should have been diagnosed earlier.
PHYSICIAN’S DEFENSE There was no negligence; the patient had rejected hysterectomy in September 2006. In addition, the cancer initially was not endometrial, but had started in an area of adenomyosis deep in the uterine wall.
VERDICT A Kentucky defense verdict was returned.
Brachial plexus injury after shoulder dystocia
AN OBESE WOMAN had gestational diabetes; the fetus was estimated to be macrosomic. When shoulder dystocia was encountered at delivery, the ObGyn delivered the child using several maneuvers. The child was born with a brachial plexus injury.
PATIENT’S CLAIM The physician was negligent in not scheduling a cesarean delivery because the fetus was large. When dystocia occurred, the ObGyn continued to apply traction to the infant’s head and neck, causing injury.
PHYSICIAN’S DEFENSE The proper maneuvers were undertaken to deliver the child as quickly and safely as possible.
VERDICT A $72,500 Texas settlement was reached.
Was informed consent neglected?
A 35-YEAR-OLD WOMAN underwent diagnostic laparoscopy in March 2005 because of severe pelvic pain. During surgery, the ObGyn observed adhesions and scarring that obstructed visualization of the pelvic area. He converted to an open procedure and discovered advanced-stage endometriosis. Because of his concern that endometriosis might perforate the patient’s colon, he performed supracervical hysterectomy.
PATIENT’S CLAIM The ObGyn was negligent in converting to an open procedure and performing the hysterectomy without obtaining informed consent. She suffered post-traumatic stress disorder because of the surgery.
PHYSICIAN’S DEFENSE The only option for treating the conditions he found was a hysterectomy. The patient had a history of anxiety prior to surgery.
VERDICT A Tennessee defense verdict was returned.
Nipples “too high” after breast reduction surgery
A 25-YEAR-OLD WOMAN underwent breast reduction surgery.
PATIENT’S CLAIM The plastic surgeon placed her nipples too high on her chest, making it impossible to find a bra that covered them, and making it difficult to find clothing to wear.
PHYSICIAN’S DEFENSE Unforeseeable postoperative changes caused the woman’s breasts to drop, giving the appearance of the nipples being too high. The nipples were properly located during surgery.
VERDICT A $170,000 Georgia verdict was returned.
Placental abruption; stillbirth follows
A 24-YEAR-OLD WOMAN AWOKE one day during the 39th week of pregnancy with abrupt onset of vaginal bleeding. She arrived at the emergency department (ED) at 12:30 am, and was transferred to labor and delivery at 1:12 am. A sonogram at 1:24 am revealed a fetal heart rate of 2 beats in 40 seconds, and a fetal scalp electrode did not register a heartbeat.
The mother was immediately prepped for emergency cesarean delivery, but a second sonogram performed in the OR showed no fetal heartbeat. Cesarean delivery was cancelled and labor was induced. The stillborn fetus was delivered vaginally several hours later, when a >60% placental abruption was found.
PATIENT’S CLAIM She was not treated in a timely manner in the ED or on labor and delivery. An emergency cesarean delivery should have been performed earlier.