Tumor Removal Complicates Pregnancy

Cody Porcoro

Written by
on October 31, 2017

A general surgeon and anesthesiologist were accused of abandoning standards of care after a pregnant woman passed away from an attempted myomectomy performed in conjunction with a C-section. During the C-section, a large non-cancerous leiomyoma growth was noticed in her lower uterine segment, and her surgeon decided to immediately perform myomectomy fibroid treatment. In the aftermath of childbirth, however, the patient’s uterus had become atonic and could not contract properly, causing excessive hemorrhaging. She was taken out of the operating room, losing three liters of blood and showing critically high hematocrit levels. No complete blood count was taken, but doctors decided to treat her for Disseminated Intravascular Coagulation, believing that small clots in the patient’s bloodstream were facilitating excessive bleeding. When no source of bleeding could be identified, surgeons performed a supracervical hysterectomy, also removing her right ovary and Fallopian tube. The patient’s heart became tachycardic, beating excessively fast as an emergency ultrasound and aspiration revealed blood flowing into her abdominal wall. Her heart went into cardiac arrest, and she passed away despite the doctor’s chest compression attempts. The trial over her doctors’ course of action needed an expert in anesthesiology to comment on whether the anaesthesia had been a contributing factor to her hemorrhage.

Question(s) For Expert Witness

  • 1. Do you routinely administer anesthesia for patients undergoing repeat C-sections?
  • 2. Are you able to opine on the standard of care for blood draws and the surgeon leaving the operating room when a patient has lost three liters of blood?

Expert Witness Response E-009280

Fibroids are a known risk factor for uterine atony and doing a myomectomy at C-section can be extremely bloody. It seems likely that there was an underestimation of the blood loss during the operation or she was bleeding severely in the Post-Anesthesia Care Unit. I am not sure there is a specific standard of care for blood draws since with hemorrhage and hemodynamic instability it is necessary to transfuse with or without lab values. I do give anesthesia routinely for elective and urgent C-sections; I have seen major hemorrhage, and have seen a patient die from it.

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