This case involves a thirty-two-year-old female who developed septic pelvic thrombophlebitis shortly after being induced for labor at a local hospital. The woman was thirty eight weeks gestation at the time of induction. During the days leading up to her induction, the patient claimed that she was never examined by a physician. On the second day of labor, her amniotic sac ruptured. Within the next twenty-four hours, the patient was never seen by a physician. She was then scheduled for a Caesarean section due to failed progression of normal vaginal labor. The patient stated that she was abruptly taken to the operating room where adequate sterile technique and surgical prepping was not followed. While in recovery, the patient developed severe burning during urination. Her physician advised her that she had a bladder infection and was discharged with penicillin the next day. A week later, the patient experienced pelvic pain and urinary symptoms which included increased frequency of urination and pain during urination. The patient was taken to the emergency room where she was diagnosed with septic pelvic thrombophlebitis, which required a month long hospitalization. Additionally, this patient had a pre-existing heart valve condition from childhood. As a result of her infection, her heart valve became severely damaged requiring corrective surgery.
Question(s) For Expert Witness
1. What measures could have been put in place to reduce the risk of the complications seen in this patient?
Expert Witness Response E-002754
There were deviations from the standard of care in this case. Primarily, proper measures were not taken to ensure a proper sterile environment for her Caesarean section. Additionally, she wasn’t properly worked up for her infection. By assuming she had a bladder infection, the gynecologist missed the diagnosis of a severe pelvic infection. Septic pelvic thrombophlebitis is a diagnosis based upon physical examination findings. Some signs include fundal tenderness, lower abdominal tenderness, and pelvic tenderness. The diagnosis should also be considered when a female has a persistent unexplained fever following the delivery of a child. The majority of patients will have leukocytosis (an elevated white blood cell count), indicating infection. Once the diagnosis is established, proper treatment must be initiated. Penicillin was the antibiotic prescribed to this patient. However, this woman’s infection required the administration of broad-spectrum antibiotics. The correct combination antibiotics for this patient should have included ampicillin-sulbactam, piperacillin-tazobactam, or ticarcillin-clavulanate, plus ceftriaxone or metronidazole. In addition to antibiotics, this patient should have also been initiated on an anticoagulants, such as heparin.
About the author
Jason Cohn
Jason is a 4th year medical student pursuing a career in Otolaryngology/Facial Plastic Surgery. His Interest include sports, fitness, chemistry, otolaryngology, plastic surgery, allergy/immunology, surgical oncology, human genetics, public health, preventative medicine, and rheumatology.
