A Virginia medical malpractice case involving the death of a patient shortly after delivering a baby was recently settled by the attorneys of Pierce & Thornton. The facts of the case involve a nineteen year old pregnant woman who presented at full term to a community hospital. After several hours of labor and an arrested descent, she was taken shortly after midnight to the operating room for a caesarean section. Approximately fifteen minutes following the successful c-section delivery of her son, she exhibited “scant” then “moderate” bleeding and decreasing blood pressure and tachycardia. The PACU nurse assessed her uterus as “boggy.” The PACU nurse alerted the defendant OB-GYN of this change in condition and defendant immediately assessed the patient. Defendant expressed clots from the uterus and noted that the fundus was firm. Defendant ordered Oxytocin drip and continued to periodically assess the patient, who continued to hemorrhage.
Approximately 15 minutes after the patient’s vitals first worsened, the physician ordered blood products and uterotonics and continued to monitor the patient, whose vitals continued to reflect hypotension and tachycardia with impending hypovolemic shock. Defendant ordered an additional IV line for fluid resuscitation and continued to monitor her patient, massage the fundus and express clots from the uterus. The patient exhibited a transient improvement in vitals but did not stabilize. The decision was made to return to the operating room for laparotomy and potential hysterectomy. The defendant ultimately performed a hysterectomy after attempting to stop the bleeding with O’Leary stitches. During the procedure, additional units of blood were transfused and additional uterotonics administered in an attempt to stop the post-partum hemorrhage. Approximately 6 hours after the hysterectomy and after transfusion of over 12 units of blood, the patient coded multiple times over a two hour period and was pronounce dead at approximately 2:15 p.m. The cause of death was DIC (disseminated intravascular coagulopathy) caused by an atonic uterus.
The allegations of negligence centered on the defendant OB-GYN’s failure to recognize the extent of the post-partum hemorrhage and act more aggressively in the resuscitation and in the decision to return the patient to the OR for a life-saving hysterectomy. Plaintiff also challenged the defendant’s decision to order cross-matched rather than universal donor blood (O negative) which was available and would have been delivered substantially faster than the 45 minutes that elapsed during delivery of the cross-matched units. Defendants contended that the OB-GYN physician had acted reasonably by assessing her patient, ordering uterotonics and fluids, blood products and had returned her to the OR within 90 minutes of first learning of her patient’s hemorrhage. The sole beneficiary in the case was the child born shortly before his mother’s death.