Mother’s hospital admissions
The mother returned to the hospital on July 12 with suspicion of retained products of conception. Apparently, since the delivery, she had some issues with vaginal bleeding. She also complained of uterine tenderness. The Defendant started the patient on antibiotics for presumed endometritis.
A sonogram performed on July 13 revealed retained products of conception. Under general anesthesia in the operating room that day, the Defendant performed a pelvic exam on the patient, following by a sonogram-guided suction dilatation and curettage (D&C). Postoperative sonograms showed a thin, endometrial stripe with no retained tissue. The notes suggested that the patient tolerated the procedure well with no adverse events. Post-procedure, a drop in the patient’s white blood cell count was documented. She was stable and discharged that same day with prescriptions for doxycycline, metronidazole, and 3 doses of methylergonovine.
The sonogram report for the July 13 procedure documented retained products of conception pre-procedure and no retained tissue post-procedure. A final surgical pathology report dated July 18 said that the pathologist received “products of conception,” consisting of an aggregate of soft, spongy red-brown tissue, with blood clots measuring 6.3 x 5 x 1.5 cm. No fetal parts were noted. The final pathological diagnosis was products of conception, with fragments of implantation site, with dilated and variably thrombosed structures consistent with converted uteroplacental vessels with prominent fresh thrombus and acute chronic inflammation. Histology was consistent with sub-involution of the implantation site with microscopic retention of products of conception.
The last Defendant hospital record for the mother was dated July 22, 2012. The emergency presentation says that the 29-year-old female, who is 1 month postpartum, and 1 week “status post life threatening vaginal bleeding taken emergently to the O.R. for D&C,” returned to the emergency room for continued vaginal bleeding. She claimed she was soaking up to
6 pads per day with clots. The note said that the patient had been diagnosed with uterine involution after the prior D&C, again noting the “life threatening hemorrhage last week.” The notes suggested that between her presentations to Defendant hospital, the patient had appeared at a nonparty Medical Center where she had a sonogram and was told that she needed to be taken back to the operating room for another D&C. A follow-up D&C was ultimately performed at the nonparty Medical Center, however, the pathology showed no retained products of conception.
The plaintiff mother contended that the Defendant negligently opted to induce labor when the estimated gestational age was
37 weeks, 4 days, despite an alleged absence of medical indication for induction before full term was reached. The plaintiff maintained that as a result of the vaginal delivery at that time, her baby suffered very substantial developmental delays and respiratory difficulties. The plaintiff also claimed that when she felt that products of conception remained and the defendant performed a D&C, it was done in a negligent manner, causing infertility. The mother testified that she, otherwise, would have had additional children.
The defendants and their experts felt the care was defensible and chose to go to trial. The defendants contended that induction at that time was proper. The defendant pointed out that the mother went to the hospital because of complaints of decreased fetal movement. The defendant further asserted that signs of potential preeclampsia, including mild headache, blurring of vision and decreasing blood pressure, justified induction at that time. The defendants also contended that when the mother complained that she felt like portions of the placenta remained, a D&C was properly performed and ruled out retention of products of conception. The defendants contended that after the mother was discharged, she went to a non-party ob/gyn who performed a D&C, which was contraindicated because of the recent procedure, and that this factor caused the infertility.
The plaintiff argued that Defendant and the hospital set up an elaborate scheme to lure the plaintiff into the hospital so he could deliver her baby before he went on vacation (19 days later) “so he would ensure he got paid.” Finally, they claimed that following the delivery, the plaintiff was allowed to bleed on multiple occasions and was denied care. Rather than focus on the medicine, opposing counsel attempted to inflame the jury’s passion and turn the case into a conspiracy.
Defendants were able to establish glaring inconsistencies in the plaintiff’s testimony, and that the infant met all appropriate milestones in the first 2 years of life, per the pediatric records. An expert in pediatric neurology evaluated the child and the medical records and confirmed that the infant suffered from autism, which has not and cannot be scientifically attributed to birth injury. The defendant obstetric expert testified that decreased fetal movement in a woman at term is, in and of itself, an indication to induce labor, but when you combine that with the early warning signs of preeclampsia, (i.e. blurred vision, headaches and increase in blood pressure), that made it an even stronger indication to induce labor in this case.
After several weeks of trial, the jury got the case and returned a fairly expedient defense verdict for the defendant obstetrician and the hospital.