Botched C-Section Leads to Hysterectomy

    OB/GYN Expert WitnessThis case takes place in New York and involves a young woman who developed uncontrollable bleeding following the birth of her second child, who was delivered by c-section. She was previously using an IUD as a form of contraceptive, but decided on having a second child. The patient had originally attempted to have her baby via a natural vaginal delivery, however multiple complications arose during labor which made a c-section necessary. Due to the irregular positioning of the patient’s uterus, the surgeon was not able to use the traditional techniques used in performing a c-section, and had to use an unorthodox procedure in order to deliver the baby. Following the procedure, both the patient and baby were judged healthy and allowed to leave the hospital. Several days later the patient returned to the hospital emergency room with severe vaginal bleeding. A hysterectomy was performed due to a significant infection in the patient’s uterus around the c-section incision, and the woman’s doctors worried that her significant blood loss indicated an amniotic fluid embolism. The patient lost a large quantity of blood and nearly died before the hysterectomy was performed. An expert in obstetrics and fertility was retained for this issue.

    Question(s) For Expert Witness

    • 1. What is the standard of care for a patient with failure to progress?
    • 2. Should the patient have been discharged with elevated white cell count?
    • 3. Was the type of incision used a departure from the standard of care?

    Expert Witness Response E-000874

    This case is very interesting and I would be happy to review. The standard of care for a patient with failure to progress is to perform an emergency C-section or vacuum or forceps delivery under some circumstances. The elevated white cell count is only one of many factors to consider when discharging a patient. I would have to review the hospital events and notes in more detail to see where the white count fits in, however it is fairly apparent that there was a significant infection that could have been avoided.

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