Legal: Pulmonary embolism after laparoscopy

A 47-year-old California woman went to her gynecologist in 2005 for evaluation of bilateral ovarian cysts. She had a history of hypertension that had been controlled by medication. A few months prior to that visit, an ultrasound revealed the presence of bilateral ovarian cysts and she had been started on an oral contraceptive. On examination her pelvis was normal and bilateral adnexal tenderness was noted. A follow-up U/S showed bilateral endometriomas and a fundal fibroid. The U/S did not show any free fluid in the pelvis. The doctor's assessment was bilateral ovarian cysts consistent with endometriomas. The patient was to return for surgery and continue taking the contraceptives to limit any growth or possible rupture of the endometriomas. She then underwent a laparoscopy, lysis of adhesions, exploratory laparotomy, and left salpingo-oophrectomy. Measures were taken to prevent deep vein thrombosis, including sequential compression stockings, which remained on until she began to walk about. The patient's postoperative course in the hospital was uneventful. A few days after the surgery, the woman returned to the hospital with shortness of breath for 2 days. She was diagnosed with a massive pulmonary embolism. She underwent surgery for the removal of several large clots and was hospitalized for a week. The discharge diagnoses included cardiogenic shock secondary to large saddle pulmonary embolism and right atrial embolism and deep vein thrombosis after ovarian cyst removal.

In the lawsuit that followed, the woman alleged the gynecologist was negligent in failing to discontinue the oral contraceptives 4 to 6 weeks prior to surgery and in light of that anticoagulation medication should have been administered a few hours before surgery. She claimed the doctor did not discuss the risk of blood clots associated with pelvic surgery.

The physician claimed continuation of OC's was necessary and that the use of the compression stockings and having the patient walk shortly after surgery was within the standard of care to decrease the risk of a thromboembolic event. She further asserted that the patient was managed appropriately and has had an excellent outcome. A defense verdict was returned.