Death due to cardiomyopathy during pregnancy
A 30-year-old California woman experienced shortness of breath and chest discomfort during her pregnancy while lying down. To alleviate the shortness of breath, she propped herself up with pillows. The woman informed her obstetrician of her symptoms and was told they were common in pregnancy. That conversation was not recorded in the patient’s medical record and no further investigation was done. A month later, the woman’s husband found her unresponsive at 24 weeks’ gestation and called an ambulance. She was taken to the hospital and immediately delivered but pronounced dead after delivery. The infant died three days later due to extreme prematurity. The woman’s autopsy showed she died due to an undiagnosed cardiomyopathy and suffered a sudden cardiac arrhythmia.
A lawsuit was filed against the obstetrician, alleging that she should have investigated the patient’s symptoms further and that her dismissal of the patient’s complaints deprived her of a proper diagnosis and treatment that could have saved her life. The lawsuit claimed an echocardiogram would have revealed the patient’s condition and she could have been treated.
The obstetrician asserted that her evaluation and determination based on the patient’s symptoms were reasonable and within the standard of care. She also maintained that because the symptoms were determined to be a result of the pregnancy, it was not necessary to note that in the chart. She also argued that it would have taken close to a month to determine the diagnosis and any treatment would have only minimized the probability of a cardiac arrhythmia, not prevented it.
The verdict: The jury deliberated for almost two and a half hours at the conclusion of an 11-day trial and returned a defense verdict.
Medical analysis from Carolyn Zelop, MD
This tragic case presentation underscores the need to educate all clinicians about the increasing prevalence of cardiac complications during pregnancy. Cardiac disease including cardiomyopathy is the leading etiology of maternal death as detailed in our opening January editorial - http://bit.ly/CVmorbidity. While the physiologic changes of pregnancy can lead to maternal complaints of breathlessness and fatigue, pregnancy can unmask congenital or acquired cardiac disease. Cardiac conditions that may precede pregnancy or be pregnancy-associated can be life-threatening including: cardiomyopathy, valvular disease or arrhythmias. Attributing these symptoms to “just pregnancy” is a diagnosis of exclusion. Any patient with persistent signs and symptoms of dyspnea requires thorough evaluation with EKG and echocardiogram.
Dr. Zelop is Director of Ultrasound, Fetal Echocardiography and Perinatal Research at Valley Hospital in Ridgewood, New Jersey, and Clinical Professor of Obstetrics and Gynecology at NYU School of Medicine, New York. She works actively with ACOG and the American Heart Association (AHA) on issues of maternal cardiac arrest and mortality. Dr. Zelop is the Series Editor of the Contemporary OB/GYN series on maternal mortality.