Obstetric Malpractice, Negligence & Mistakes

Obstetrical emergencies are life-threatening medical conditions that occur in pregnancy particularly during or shortly after labor and delivery.

Any medical procedure is fraught with potential dangers but these can be compounded by obstetric malpractice or negligence due to simple human errors causing medical mistakes. As a lawyer we need to establish on the balance of probabilities, that is more than 50%, that the medical gynaecologist or obstetric specialist acted in a manner that was careless, out of line with medical peer group or neglectful causing damages to either or both the mother of the newly born child or the newborn.

The most common reasons for gynaecological and obstetric negligence/hospital claims relates to brain damage known as neurological impairment (about 30%), stillbirth (14%), delay in diagnosis or failure to diagnose (11%). Gerard Malouf and Partners compensation and medical lawyers are experts at assisting victims of medical malpractice and medical mistakes to obtain justice and maximum compensation having run thousands of medical negligence cases involving hospitals, nurses, medical specialists, general practitioners and other medical contractors.

Obstetricians and gynaecologists are likely to be involved in a medical malpractice negligence case because of a few simple reasons: –

  • Specialist birth doctors cannot be in two places at once.  As an example they can’t perform an abdominal hysterectomy and also deal with another patient having early labour problems that are critical. Problems arise because of the delay of the specialist gynaecologist/obstetrician attending a critical situation that has developed. The patient did not get the attention required
  • Cases occurred because hospital staff supervising birthing are excessively due to working strenuous hours and taking on far too many cases particularly second and third year residents who are on call for more than 48 hours.  There are a high proportion of medical negligence cases arising in the early hours after midnight.  Often a call is made for an urgent Caesarean and if one were to investigate the facts the Caesarean could have been avoided had appropriate prenatal records been monitored during the course of the pregnancy to highlight an imminent and critical issue that should have been dealt with earlier.  Often under these circumstances a child is born with some form of neurological damage due to hypoxia also known as lack of oxygen.
  • Hospitals and doctors knowing that there is a critical gynaecological problem is likely to develop are often faced with a malpractice claim on the basis that they did not adequately prepare for the emergency by having anesthetists, critical care people, and cardiologists available to undertake the appropriate investigations.  Preparation and training needs to be undertaken regularly by medical staff simulating potential and likely problems that will occur from time to time but this doesn’t always eventuate in public or private healthcare systems.  The Achilles heel of many hospitals and medical specialists relate to the notification of problems once a critical situation develops and a chain of command should be set up in advance to deal with these situations as quickly as possible but once again this does not always occur leading to huge complications and ramifications for both the pregnant mother and newborn child.  Examples where problems have occurred relates to the child being caught in the birthing canal, consequentially suffering brain injury due to lack of oxygen or where Forceps are required to be used but should have been utilised much earlier or in a more delicate manner to avoid shoulder distosis.
  • Following any incident at a hospital whether it be public or private, a RCA (root cause analysis) must be undertaken and can be discovered by obtaining copies of the medical notes at that institution where the unfortunate outcome occurred.  Of course not all unfortunate birthing outcomes are attributable to negligence of the doctor, specialist obstetrician or nursing staff but a careful review of the root cause analysis report will generally give some clear indication as to why an incident occurred and whether it could have been reasonably avoided.

Examples of areas of obstetric practice that can develop into emergencies due to medical malpractice/negligence:-

Obstetrical emergencies of pregnancy
 
ECTOPIC PREGNANCY

An ectopic, or tubal, pregnancy occurs when the fertilized egg implants itself in the fallopian tube rather than the uterine wall.  If the pregnancy is not terminated at an early stage, the fallopian tube will rupture, causing internal hemorrhaging and potentially resulting in permanent infertility due to loss of the fallopian tube.

PLACENTAL ABRUPTION

Also called abruptio placenta, placental abruption occurs when the placenta separates from the uterus prematurely, causing bleeding and contractions.  If over 50% of the placenta separates, both the fetus and mother are at risk. This needs to be picked up immediately by the obstetrician.

PLACENTA PREVIA

When the placenta attaches to the mouth of the uterus and partially or completely blocks the cervix, the position is termed placenta previa (or low-lying placenta).  Placenta previa can result in premature bleeding and possible postpartum hemorrhage. The unborn child suffers stress. Fetal monitoring is critical.

PREECLAMPSIA/ECLAMPSIA

Preeclampsia (toxemia), or pregnancy-induced high blood pressure, causes severe edema (swelling due to water retention) and can impair kidney and liver function.  The condition occurs in approximately 5% of all United States pregnancies.  If it progresses to eclampsia, toxemia is potentially fatal for mother and child.

PREMATURE RUPTURE OF MEMBRANES (PROM)

Premature rupture of membranes is the breaking of the bag of waters (amniotic fluid) before contractions or labor begins.  The situation is only considered an emergency if the break occurs before thirty-seven weeks and results in significant leakage of amniotic fluid and/or infection of the amniotic sac.

AMNIOTIC FLUID EMBOLISM

A rare but frequently fatal complication of labor, this condition occurs when amniotic fluid embolizes from the amniotic sac and through the veins of the uterus and into the circulatory system of the mother.  The fetal cells present in the fluid then block or clog the pulmonary artery, resulting in heart attack.  This complication can also happen during pregnancy, but usually occurs in the presence of strong contractions.

INVERSION OR RUPTURE OF UTERUS

During labor, a weak spot in the uterus (such as a scar or a uterine wall that is thinned by a multiple pregnancy) may tear, resulting in a uterine rupture. In certain circumstances, a portion of the placenta may stay attached to the wall and will pull the uterus out with it during delivery. This is called uterine inversion.

PLACENTA ACCRETA

Placenta accreta occurs when the placenta is implanted too deeply into the uterine wall, and will not detach during the late stages of childbirth, resulting in uncontrolled bleeding.

PROLAPSED UMBILICAL CORD

A prolapse of the umbilical cord occurs when the cord is pushed down into the cervix or vagina. If the cord becomes compressed, the oxygen supply to the fetus could be diminished, resulting in brain damage or possible death.

SHOULDER DYSTOCIA

Shoulder dystocia occurs when the baby's shoulder(s) becomes wedged in the birth canal after the head has been delivered. Careful and immediate use of forceps is required. However, many of these complications can be anticipated via an experienced practitioner and avoided.

BRAIN INJURY AND BIRTH DEFECTS

As a result of poor obstetric and gynaecological treatment brain injury and multiple birth defects resulting in loss of oxygen to the unborn child can occur. If the unborn child experiences foetal distress and this is not monitored appropriately by hospital staff and/or the obstetrician and goes undetected even for a short period of time, perhaps only 10 to 20 minutes, significant you irrepairable brain damage can occur. The side-effects would likely result in permanent loss of speech, partial or total paralysis of the nervous system, greatly reduced brain and cognitive functioning. Whilst the child may survive birth the impact on the family and parents is devastating because of the immense home care, maintenance and financial burden required to raise a brain injured child with multiple birth defects.

Obstetrical emergencies postpartum

POSTPARTUM HEMORRHAGE OR INFECTION

Severe bleeding or uterine infection occurring after delivery is a serious, potentially fatal situation. This needs to be monitored and treated quickly often with strong intravenous drugs.

Many of the above complications can be avoided by careful fetal monitoring, pelvimitary investigations, reviewing previous birth histories, monitoring of blood samples and pressure, quick and immediate reactions to developing medical conditions.