Failure to appropriately work up bleeding

May 21, 2008

In 1999, a 38-year-old Illinois woman had an uneventful prenatal course until almost term when she presented with back and abdominal pain and persistent vaginal bleeding. She was admitted to the hospital for evaluation and after about 1 hour of monitoring, it was determined she was not in labor and the FHR was reassuring. The woman was discharged home despite continued bleeding and some abdominal pain. When the patient returned to the doctor's office that afternoon with complaints of increased bleeding and pain, she was advised to go to the hospital. While in route, she had a large amount of bleeding just before arriving at the hospital. A fetal demise was diagnosed from placental abruption before an emergency C/S could be performed. The patient required transfusions for DIC.

In 1999, a 38-year-old Illinois woman had an uneventful prenatal course until almost term when she presented with back and abdominal pain and persistent vaginal bleeding. She was admitted to the hospital for evaluation and after about 1 hour of monitoring, it was determined she was not in labor and the FHR was reassuring. The woman was discharged home despite continued bleeding and some abdominal pain. When the patient returned to the doctor's office that afternoon with complaints of increased bleeding and pain, she was advised to go to the hospital. While in route, she had a large amount of bleeding just before arriving at the hospital. A fetal demise was diagnosed from placental abruption before an emergency C/S could be performed. The patient required transfusions for DIC.

The woman sued and claimed she was discharged the first time without an appropriate work up for the persistent bleeding and abdominal pain. She contended that an ultrasound should have been done and she should have been admitted.

The obstetrician claimed the patient was sent home because her condition had improved and delivery was not imminent. He also claimed the sudden massive placental abruption was unpredictable. A $1.6 million verdict was returned.. The cause of her problems, he contended, could have been her use of psychiatric medication which could have led to neurogenic bladder failure. A defense verdict was returned.