Legally Speaking

Forceps delivery results in skull fractures In October 1995, an Illinois obstetrician used forceps to deliver an infant after the mother had pushed for more than 2 hours. The first set of forceps slipped off the baby's head twice, so the obstetrician requested and used a second set of forceps to deliver the baby. She had examined both forceps before use, but when she looked at them again side by side after the delivery, she noticed a subtle asymmetry in the first set, which was believed to be the cause for the slippage.

The infant sustained bilateral "ping-pong" skull fractures during delivery, which were repaired by a neurosurgeon several days later. She still has permanent "baseball seam"-type scars on her head.

A lawsuit was filed against the obstetrician, who maintained that the forceps were properly examined before use, the residual asymmetry was subtle, and the use of forceps for the delivery was appropriate. The jury returned a defense verdict.

In the case described here, the indication for using forceps was a prolonged second stage.While the injury was obviously from the forceps and the residual damage minimal, the jury found for the defense because the indication was appropriate.

Failed D&C results in normal infant An Ohio woman learned she was pregnant in November 2001. At 7 weeks' gestation, she was seen by her obstetrician, who ordered an ultrasound as he suspected a blighted ovum. The physician recommended that a D&C be done the next day. Three months later, the woman suspected that she was still pregnant and went to her doctor's office. She was diagnosed as still being pregnant and the physician told her he could not assure her that the baby would be uninjured. The baby was born without injury, but the woman continued to have anxiety and depression about her daughter, which has almost developed into a psychosis.

She sued the physician, alleging negligence in failure to perform further testing before performing the D&C.

The physician argued that relying on the U/S was reasonable and that the woman's fears were unreasonable. The patient was awarded damages of $372,000 on her negligence claim; posttrial motions are pending.

Severe shoulder dystocia A North Carolina woman had previously delivered an infant with shoulder dystocia, which resulted in Erb's palsy. She told her obstetrician about this history during her next pregnancy and asked about cesarean delivery. Her prenatal care was provided primarily by a nurse practitioner and assessments of fundal height indicated a large infant. During an attempted vaginal delivery, a shoulder dystocia was encountered. When maneuvers to relieve the dystocia failed, a cesarean incision was made and cephalic replacement was attempted, without success. The child was ultimately delivered with a broken neck, clavicle, and arm. The infant suffered massive brain damage, cortical blindness, and is a C2 quadriplegic dependent upon a ventilator and gastrostomy tube.

The woman sued the obstetrician and a $13.5 million settlement was reached after four attempts at formal mediation.

Ruptured uterus during vaginal delivery A 29-year-old woman went to a New York hospital in June 2001 for a planned C/S because of breech presentation. An U/S performed that day showed the fetus was no longer breech and the C/S was cancelled when the patient chose elective induction of labor. Later that day she delivered vaginally and was found to have a ruptured uterus. During the uterine repair, a suture was placed in the woman's ureter. She required a nephrostomy for 1 month while the ureter healed.