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Vacuum Extraction for Shoulder Dystocia

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Vacuum Extraction for Shoulder Dystocia MEDICAL VERDICTS NOTABLE JUDGMENTS AND SETTLEMENTS IN BRIEF Vacuum extraction Verdict $487,000 Indiana verdict. An appeal for shoulder dystocia was pending. For more on twin gestations, see the A 28-year-old woman in labor presented cover article by Victoria Belogolovkin, MD, at the hospital. While delivering her child, and Joanne Stone, MD, on page 66 the ObGyn encountered shoulder dysto- cia and proceeded to use vacuum extrac- tion. Diagnosed with Erb’s palsy, the child has undergone physical and occupational Oversized head went therapy and is now doing well. unnoticed despite US Patient’s claim The ObGyn did not man- A woman in her 17th week of pregnancy un- age the shoulder dystocia properly. Vac- derwent ultrasonography (US) with radiolo- uum extraction, which was not needed, gist A to check for a fetal heartbeat and to was performed by® anDowden inexperienced Healthas- confi rm Media both the presence of the fetus in the sisting physician after shoulder dystocia uterus and a single pregnancy. She also un- had occurred. Asymmetry of the child’s derwent a blood test for Down’s syndrome, chest,Copyright as well Foras arm personal length discrepancy, use Trisomyonly 18, and neural tube defects. All tests will increase as the child grows. were normal. At her next appointment, radi- Doctor’s defense Vacuum extraction was ologist B used US to verify the sex of the fe- used to alleviate stress on the infant, who tus. The remainder of her pregnancy passed had mitral valve prolapse. The assisting without incident. The child was delivered by physician was directly observed and su- cesarean section and had a grossly enlarged pervised by the ObGyn, who was per- head and other congenital defects. An MRI forming the McRoberts maneuver. 2 days later showed the right hemisphere of Verdict New York defense verdict. the brain to be huge with a severely abnor- mal structure. The child had multiple brain surgeries but continues to suffer from intrac- Monochorionic mono- table seizures. He is severely retarded and has been diagnosed with Proteus syndrome, amniotic twin dies also known as Elephant Man syndrome. A 29-year-old woman pregnant with mono- Patient’s claim Instead of limited US on 2 chorionic, monoamniotic twins was ad- occasions (which led her to believe the fetus mitted to the hospital when she went into was normal), a full US should have been premature labor. Despite her request for de- done. This would have allowed the brain livery, the ObGyn decided to delay delivery abnormalities to be diagnosed while there and administered terbutaline. Five days later, was still time for a legal abortion. During the twins were delivered: one healthy, the the second US, Dr. B noted that the baby other stillborn. had a big head. The sonogram taken by Dr. Patient’s claim Delivery should have oc- A showed the early stages of disease, and if curred earlier, before the one fetus had died. Dr. B had taken one during the second US, Doctor’s defense Unpredictable and un- the dramatic difference in head size would preventable complications of the pregnancy have been evident. She denied that she re- caused the stillbirth. quested the second US to verify the sex. CONTINUED 86 OBG MANAGEMENT • July 2007 For mass reproduction, content licensing and permissions contact Dowden Health Media. MEDICAL VERDICTS CONTINUED Doctor’s defense Dr. A claimed he tells all Patient’s claim The hysterectomy was un- patients that US does not look for fetal ana- necessary and lacked informed consent. The tomical abnormalities and that they can be physician said she had cancer and would die referred to a perinatologist for that informa- without the hysterectomy, but cancer was tion. Dr. B claimed the second US was only not found. A repeat D&C was warranted. to verify the sex. Both denied liability, claim- Doctor’s defense He stopped the original ing that the child’s disorder is very rare and surgery because he didn’t want to perfo- a full US was not needed. Also, a diagnosis rate the bowel; he never told the patient might not have been made, and it was un- she had cancer; and a simple hysterectomy likely the fetus would have been aborted. cannot cause incontinence. Verdict California defense verdict. Verdict New York defense verdict. Small bowel is injured FP, not OB, delivers in repeat C-section severely injured child A 25-year-old woman underwent a second A woman hospitalized at 38 weeks’ gesta- cesarean section performed by the same OB tion—with high blood pressure and at risk who had handled her fi rst cesarean section 3 for toxemia—was diagnosed with preg- years earlier. During the second procedure, nancy-induced hypertension (PIH). Fetal the small bowel was perforated, requiring monitoring showed the fetus to be stable. emergency intraoperative corrective surgery. The woman was given magnesium sulfate Patient’s claim She lost 3 inches of her small for the PIH, misoprostol and oxytocin to bowel and suffers severe intermittent diar- induce and augment labor, and an epidural. rhea, pain, and a partial bowel obstruction. After decelerations were noted the following Doctor’s defense The woman’s problems pre- evening, amnioinfusion was ordered. Scalp dated the cesarean section. She was not un- stimulation 3 hours later yielded no re- der a doctor’s care or taking medication, and sponse. Oxygen saturation of the fetus was she had not been hospitalized since the cor- normal. Oxytocin was increased, and the rective surgery. Bowel perforation, a known infant was delivered several hours later, but risk, was complicated by a bowel loop ad- required 10 minutes of resuscitation before herent to the abdominal rectus muscle. Also, it began breathing. The diagnosis was severe the woman was not a candidate for vaginal hypoxic–ischemic encephalopathy, and the delivery because of her history: colostomy, child requires a ventilator and tube feeding. blood transfusions, digestive problems, and Patient’s claim The family practice phy- failure to progress in the fi rst pregnancy. sician should have transferred care to an Verdict New York defense verdict. obstetrician, and a cesarean section should have been performed. Doctor’s defense Not reported. Why a hysterectomy Verdict Mediated California set tlement: $3.4 million from the hospital, $100,000 from and not another D&C? the obstetrical group, and $1.5 million from A 72-year-old woman with a uterine polyp an unidentifi ed defendant. ■ presented at the hospital for a dilation and curettage (D&C) procedure. Because of The cases in this column are selected by the editors of OBG MAN- her stenotic cervix, which was abnormally AGEMENT from Medical Malpractice Verdicts, Settlements & Ex- perts, with permission of the editor, Lewis Laska, Nashville, Tenn constructed, the physician discontinued the (www.verdictslaska.com). The available information about surgery after trying unsuccessfully to dilate the cases is sometimes incomplete; pertinent details may be unavailable. Moreover, the cases may or may not have merit. the cervix. The patient later underwent ab- Still, these cases represent types of clinical situations that may result in litigation and are meant to illustrate variation in verdicts dominal hysterectomy and developed in- and awards. Any illustrations are generic and do not represent continence and constant pelvic pain. a specifi c legal case. 88 OBG MANAGEMENT • July 2007.
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