Discharged patient sues after partial delivery of breech fetus at home

December 1, 2011

The woman sued those involved with her care and claimed there was both failure to follow up on the fact that she was breech at 38 weeks and negligence in sending her home from labor and delivery with her complaint of contractions and a breech fetus. A defense verdict was returned.

During a digital exam, the PA did not feel the baby's head down, so an ultrasound was performed and found the fetus was in a breech position. The PA told the patient to return in one week for the physician to recheck the fetal position. A notation was made in the chart that the cervix was closed and the fetus was breech, and the patient was given detailed instructions on what to do if she believed she was in labor. Although the physician's practice was for the PA to report any problems to the physician regarding patients, this visit was not mentioned to the doctor and the doctor did not review the chart.

Around midnight on the day prior to the scheduled visit, the patient went to the hospital with contractions. She was examined by a labor and delivery nurse, who found the cervix fingertip dilated and the fetal heart rate reassuring. The nurse reported the results of her exam to the physician and the patient was discharged as authorized. Less than an hour after discharge the patient partially delivered the fetus at home. Her husband called 911 and emergency medical technicians found her with a partially delivered breech fetus. She was taken by ambulance to the hospital, where a stillborn baby was delivered. The patient had significant postpartum bleeding that necessitated a hysterectomy. She had multiple procedures and blood transfusions, became comatose, and was in intensive care for 11 days, but she eventually recovered.

Was this hysterectomy necessary?

A 28-YEAR-OLD Kansas woman complained of pelvic pain and went to a gynecologist. Three months after her initial visit he diagnosed endometriosis and recommended the removal of her uterus and ovaries. The patient consented to the operation but her pain was not eliminated by the surgery.

The woman sued the physicians involved in her surgery and alleged negligence, maintaining that she did not, in fact, have endometriosis. She also claimed that proper testing had not been performed before the surgery and alleged that there was lack of informed consent.

The physicians claimed that the patient did indeed have endometriosis and that she had been fully informed regarding the surgery. A defense verdict was returned.

Death linked to bowel perforation during vaginal hysterectomy

A 54-YEAR-OLD WOMAN underwent a total vaginal hysterectomy at a North Carolina regional medical center. Her gynecologist performed the operation and the woman was discharged the next day. Several hours after discharge the patient suffered severe abdominal pain and was taken back to the emergency department, where she was readmitted for evaluation. Her gynecologist examined her and intravenous antibiotics and fluid management were started. The patient was transferred to the intensive care unit the next day, at which time a surgeon performed a diagnostic laparoscopy. A bowel perforation was found and repaired, but she continued to deteriorate and was transferred to another hospital; however, she never recovered from her complications and died 3 months later.

A lawsuit was filed against the physicians, claiming that the gynecologist had failed to recognize a perforation of the sigmoid colon during the hysterectomy, failed to properly monitor her immediately following the surgery, and improperly discharged her despite abnormal pulse rates, elevated temperature, and an increased white blood count. It was alleged that both physicians failed to diagnose and treat the perforation in a timely manner and that the delay in diagnosis and treatment led to her death.

The physicians claimed the diagnosis of perforation was made as timely as possible and denied any negligence in her care. A $7 million verdict was returned against the gynecologist only, and a defense verdict was returned for the surgeon.