Legal: Postpartum bleeding results in Asherman's syndrome

September 1, 2009

A 26-year-old Illinois woman had significant vaginal bleeding 3 weeks after her delivery.

A 26-YEAR-OLD ILLINOIS WOMAN had significant vaginal bleeding 3 weeks after her delivery in 2003. She was instructed by her physicians to go to an emergency room. She presented to the ER with complaints of significant bleeding and dizziness. The ER exam found large blood clots and an ultrasound found probable retained products of conception and/or blood clots. An obstetric consult was obtained and diagnosed retained placenta causing secondary postpartum bleeding. A D&C was ordered and when the patient's physician arrived, she administered oxytocin and methylergonvine to stop the bleeding and did an exam under anesthesia. The bleeding continued and a D&C was performed and stopped the bleeding; the patient was discharged a few hours later. The D&C pathology report that came back stated that there was no evidence of retained placenta. The plaintiff developed Asherman's syndrome, leaving her unable to become pregnant.

The patient sued those involved with her care, and claimed they were negligent in diagnosing retained placental tissue, failing to provide conservative treatment for an adequate length of time to stop the bleeding, and in performing an unnecessary D&C.

The defense maintained that the actual tissue and pathology slides confirmed there was retained placental tissue that required removal. The same hospital pathologist who issued the initial report later re-examined the tissue slides and admitted there was retained placental tissue and that she had made an error in the original report. They also claimed that medications had been used in an attempt to stop the bleeding, but failed, and thus the D&C was necessary to save the patient's life. The defendant also pointed to the consent form the patient signed that had included the performance of a total abdominal hysterectomy if the bleeding could not be stopped, which would have also left her unable to bear any more children. A $731,124 verdict was returned, which included $50,000 to the patient's husband.