Legal: Failed episiotomy repair

May 1, 2009

After woman delivers and is discharged from hospital, she is found to have rectal-vaginal fistula.

In 2004 a California woman was admitted to a hospital for induction of labor for being past her due date. The next day, another physician took over for her attending obstetrician and the patient became completely dilated and began pushing. But she became exhausted shortly thereafter. The doctor opted for a vacuum-assisted delivery and an episiotomy was performed. The episiotomy extended to a fourth-degree laceration and was immediately repaired.

Discharged from the hospital without problems, she was given instructions regarding the repair, including to refrain from sexual intercourse for at least 6 weeks, and to schedule a follow-up office visit in 10 days. When she came to the office complaining of significant constipation, the physician found the surgical repair broken down and a rectal-vaginal fistula. She was given a return appointment, but sought care elsewhere and subsequently underwent two corrective operations. She then sued the delivering obstetrician and claimed negligence in failing to properly perform the initial repair.

The physician argued that the patient had recovered well in the hospital with no complications and said the failure of the repair was caused by trauma from the patient's engaging in intercourse earlier than prescribed and from stress caused by constipation. A defense verdict was returned.