July Case Summaries

When a claim that excessive traction caused brachial plexus injury doesn't hold up

A lawsuit filed in Georgia claimed that excessive traction was used by an obstetrician when a shoulder dystocia was encountered during delivery and caused a brachial plexus injury.

The physician countered that the injury was caused when the forces during descent caused the shoulder to be caught behind the symphysis, not from any further traction, and that this damage was compounded by the mother's obesity. The obstetrician also pointed to the fact that the lay witnesses present in the delivery room all testified they did not see him apply any traction to the infant's head after the shoulder dystocia occurred. A verdict for the physician was obtained. An appeal was pending.

In this case the obstetrician specifically claimed that he stopped pulling when the shoulder dystocia occurred and utilized a McRoberts maneuver. This is key to defending these cases; once a shoulder dystocia is encountered, no further traction on the head should be employed until maneuvers are done that might dislodge the shoulder. This must be documented in the delivery note. The testimony from other witnesses to the delivery that the traction was discontinued may aid the defense, as in the case described.

Further aiding the defense here was the fact that on cross-examination, the plaintiff's expert apparently conceded that he had inferred negligence and the use of excess traction, just from the occurrence of the injury. It is also important that the jury understand that the brachial plexus can be injured during descent when the shoulder is lodged behind the symphysis with or without any further traction. In these cases, the claim of excessive traction is always made, since that connects the person performing the delivery to the injury. In this case, since that connection was not made, the trial judge directed a verdict for the physician after the defense concluded their case-in-chief.

Claim that failure to do C/S results in pubic symphysis diastasis

A 36-year-old Georgia woman went back to her obstetrician for her second pregnancy in 2001. She had an uncomplicated course and was admitted to the hospital in labor at term. The next morning she was completely dilated and began pushing. After 2 hours, forceps were used to assist delivery; during the delivery an audible popping sound was heard and the physician made a notation in the records of a possible fracture of the coccyx. The patient experienced a great deal of pain after delivery and a pelvic CT scan revealed a pubic symphysis diastasis (PSD) of approximately 3 cm. The patient was discharged 6 days after delivery with arrangements for home care, a nursing evaluation, equipment at home, and a follow-up appointment with an orthopedist. The PSD healed prior to trial.

The woman sued the obstetrician, however, and claimed that a C/S should have been performed when there was inadequate fetal descent during the second stage of labor. She claimed that cephalopelvic disproportion (CPD) was present and that excessive force was used in the forceps delivery.

The physician argued that there was no CPD and also denied excessive force was used. He further argued that PSD was a known risk of pregnancy and delivery. A defense verdict was returned.

Stenotic cervix hinders D&C procedure

A 72-year-old New York woman was diagnosed with a uterine polyp in 2001. After dilation and curettage was recommended, she consulted with a gynecologist, who concurred in the recommendation. During the procedure, the physician found the patient to have a severely constricted stenotic cervix and could not finish the D&C. He did make several unsuccessful attempts to dilate the cervix before discontinuing the operation. Several months later the woman underwent a total abdominal hysterectomy.

The woman then sued the gynecologist when she soon developed some incontinence and constant pelvic pain. She alleged negligence in the performance of the D&C, that the total hysterectomy was not necessary, and that there was a lack of informed consent to the hysterectomy. The woman claimed that the physician told her that she had cancer and would die if the hysterectomy was not performed. She noted that she did not have cancer and that a repeat D&C should have been offered as an option.