Legally Speaking: Uterine rupture

A Michigan woman presented to the hospital at 37 weeks’ gestation with complaints of contractions and abdominal pain. She had a history of cesarean section and was scheduled for a repeat cesarean at 39 weeks.

The woman was seen by the nurses and her obstetrician was consulted by phone. Her cervix was found to be 0.5 cm dilated and the monitor showed irregular contractions and a normal fetal heart rate (FHR). She was given medication to stop the contractions and when she reported her pain level to be 0/10, she was discharged home.

The next night after midnight, the woman returned with further complaints of abdominal pain (9/10) and contractions. The monitor showed that she was contracting and she was admitted to the hospital. Six times over the course of 8 hours, the nurses spoke via phone with the obstetrician, who prescribed 3 doses of pain medication in response to the patient’s complaints of pain. The patient paged the nurses for help throughout the night and also called the obstetrician on his personal cell phone to tell him she was in pain and to ask him to help her. The obstetrician told her an ultrasound would be done and the baby delivered in the morning.

The woman’s pain was mostly nonresponsive to medication and the FHR became non-reassuring at 8 am. Five minutes later, a cesarean was ordered via phone by the obstetrician, who stated he was on his way to the hospital. The surgery was started at 8:52 am by another obstetrician who was at the hospital. The attending obstetrician arrived just after the incision. The fetus was found floating outside the ruptured uterus and was delivered at 8:54 am. He suffered hypoxic ischemic encephalopathy with resulting severe brain damage and was transferred to the neonatal intensive care unit where he received hypothermia and was hospitalized for 84 days. After cooling therapy was completed, the parents were informed that the infant had a 70% chance of cerebral palsy (CP). Feeding tube placement was required and the infant was moved to a long-term care facility and diagnosed with spastic quadriplegic CP. During the child’s first year of life, he required hospitalization for many episodes of aspiration pneumonia, and a tracheostomy was eventually placed. The child can hear but can only see light. He requires assistance with all activities of daily living and will need 24-hour care for the rest of his life.

A lawsuit was filed on behalf of the child and alleged negligence by the obstetrician in delaying the delivery when the patient was in the hospital contracting and had severe abdominal pain. Thus, the uterus was allowed to rupture, which caused the child’s severe brain injury.

The verdict: The case settled for $9 million.

Postpartum hypertension results in brain damage

A 38-year-old Georgia woman was admitted to the hospital near term with a history of pregnancy-induced hypertension and diagnosis of preeclampsia. Her child was delivered, and over the next 2 days the woman’s blood pressure was uncontrolled and she became hypertensive. Two days after delivery, she complained of shortness of breath. Despite decreasing urinary output, she continued to receive intravenous fluids. She became hypoxic and collapsed, lost consciousness, and suffered a cardiopulmonary arrest. Without oxygen for over 10 minutes, she suffered permanent brain injury.

A lawsuit was filed on behalf of the patient and her husband against the obstetrician and his practice alleging that the obstetrician failed to monitor and treat the patient’s condition following the delivery of her child. Specifically, he failed to appreciate the seriousness of the patient’s condition after being notified several times by nurses that the patient was experiencing shortness of breath, hypertension, and decreased urinary output, and he continued to give the patient more fluids resulting in fluid imbalance. It was alleged that the obstetrician failed to make a treatment plan, monitor, read notes, review records, and appreciate the seriousness of the nurses’ reports regarding the patient.

The obstetrician argued that the standard of care was met during postpartum care of the patient.

The verdict: The jury award included: $565,624 past medical cost; $6.7 million future medical cost; $252,238 past lost earnings capability; $736,886 future lost earnings capability; $492,055 past loss of services; $1.065 million future loss of services; $18 million personal injury and $18 million past/future loss of consortium.

Fetal demise after diabetic ketoacidosis

A Mississippi woman was 22 years old when she became pregnant for the third time in 2012. She was managed by her obstetrician, who ordered a glucose test to screen for gestational diabetes. The woman failed the test and returned a few days later for a 3-hour glucose tolerance test. She passed 3 of the 4 glucose levels and was told this was consistent with her not having gestational diabetes. The pregnancy progressed normally until her prenatal visit at 33 weeks’ gestation, at which point she had lost 8 lb in 2 weeks and urine testing revealed both glycosuria and ketonuria. A week later, the patient went to the emergency room, was diagnosed with diabetic ketoacidosis (DKA) and was transferred to a women’s hospital. By the time she arrived at the hospital, her fetus had died.

The woman sued the obstetrician and alleged the diabetic testing at 28 weeks was substandard and she should have been diagnosed with gestational diabetes at that time. Her expert witness opined that the combined findings at her last prenatal visit at 33 weeks demanded immediate intervention to salvage the pregnancy.

The obstetrician denied all allegations and any liability. His expert witness opined that the patient’s DKA developed after the last prenatal visit. A second expert alleged the patient most likely had a viral illness at the time of her last prenatal visit and that illness caused pancreatic damage, which in turn led to a transient diabetic condition that further progressed to DKA.

The verdict: The jury returned a defense verdict after a 4-day trial.