September 15 Case Summaries

Failed VBAC results in cerebral palsy

A 37-year-old California woman had previously delivereda child by cesarean for breech presentation. In 1995, duringher second pregnancy, her physicians advised her to try vaginaldelivery, and she agreed. At 42 weeks’ gestation she wasadmitted for induction. Despite her pushing for severalhours, the head remained at +2 to +3 station, at whichpoint the obstetrician recommended a repeat C/S. Thepatient refused. About an hour later a vacuum was appliedand fundal pressure given, which were unsuccessful. About ahalf hour later the physicianagain recommendedC/S, which the patientagain declined. Forcepswere attempted, but wereabandoned when theobstetrician felt he couldnot position them properly,and the patient againrefused a C/S. The physicianordered more fundalpressure, and when thenurses refused, the husbandapplied fundal pressure.After a few minutesthe woman consented toa C/S. The infant wasborn with a largecephalohematoma, facial bruising, swelling, and began havingseizures within 3 hours of delivery. She was subsequentlydiagnosed with cerebral palsy, right-sided paralysis,cognitive deficits, and learning disabilities.

In the lawsuit that followed this delivery, the patientalleged negligence by the obstetrician in that he failed to provide sufficient information to the patient aboutcesareans during labor. She also claimed he was negligentin attempting the vacuum, forceps, and fundal pressure.They alleged the pressure caused distortion of the internalcarotid artery, which caused the formation of an embolus,which in turn traveled to the right middle cerebral artery,causing an infarction in the brain.

Delay in diagnosingbreast cancer

A 36-year-old New York woman was diagnosed withstage IV breast cancer in 2003. About 5 years earlier,when she first became a patient of her gynecologist, shehad told him of her family history of breast cancer, fibrocysticbreast disease, and galactorea. The gynecologistexamined the patient repeatedly, but did not order anymammograms. In 2003, the patient requested a mammogramand she was diagnosed with cancer.

The patient sued her gynecologist, claiming that he wasnegligent in failing to order mammograms earlier.

The physician argued that without any indication, ascreening mammogram has not been shown to providebenefit for a 36-year-old, and that the care was within thestandard. A $1.25 million settlement was reached.