Uterine rupture in VBAC patient while physician at home

December 11, 2007

In 2002, a Texas woman presented to the hospital in active labor. She had undergone a C/S in 1995, but was attempting VBAC for this delivery. The on-call physician was called soon after the patient's arrival and informed of her condition; he ordered an epidural but remained at home. About 6 hours later, a uterine rupture was suspected and the doctor was called at home; the anesthesiologist, who was still at the hospital, was also advised of the emergency situation. About 20 minutes later the physician began the incision for the emergency C/S. The operation revealed the uterine rupture with the infant outside the uterus, the left uterine artery injured, and the placenta abrupted with about 1,500 mL of blood in the abdominal cavity. The umbilical cord was around the neck twice. The patient survived with her uterus intact, but the infant sustained brain damage and died 2 years later.

In 2002, a Texas woman presented to the hospital in active labor. She had undergone a C/S in 1995, but was attempting VBAC for this delivery. The on-call physician was called soon after the patient's arrival and informed of her condition; he ordered an epidural but remained at home. About 6 hours later, a uterine rupture was suspected and the doctor was called at home; the anesthesiologist, who was still at the hospital, was also advised of the emergency situation. About 20 minutes later the physician began the incision for the emergency C/S. The operation revealed the uterine rupture with the infant outside the uterus, the left uterine artery injured, and the placenta abrupted with about 1,500 mL of blood in the abdominal cavity. The umbilical cord was around the neck twice. The patient survived with her uterus intact, but the infant sustained brain damage and died 2 years later.

In the lawsuit that followed this delivery, the patient claimed that the physician should have come to the hospital when he was called the first time because the patient was undergoing a VBAC. She also claimed the nurses were negligent in failing to insist he come to the hospital or going up the chain of command. The parties disputed the true incision time and arrival time of the doctor. The patient also claimed the physician did not document the left uterine artery injury and made this up at a later date along with the placental abruption, which was not reported by the pathologist.

The nurse assigned to care for the patient came from an outside registry company and the hospital reached a confidential settlement prior to trial.

The defense claimed that the physician's decision to stay at home was reasonable and that when the uterine rupture occurred he arrived in a timely fashion just as the mother was ready for incision, so there was no delay in performing the procedure. The jury found the settling hospital negligent with a verdict of over $2.9 million. Post-trial motions were pending.