Patient Suffers Uterine Infection After Childbirth

In this case, a female patient suffered serious complications after giving birth to her first child. The patient, a 35 year old woman with no significant medical history, had recently given birth to a baby boy after a delivery complicated by an intra-amniotic infection. Some time after giving birth, the mother returned to the hospital complaining of an abnormal discharge, pain in her lower abdomen, and constipation. After being seen by a doctor, it was discovered that the patient had retained placental tissue from her delivery. The physician then performed emergency dilation and curettage on the patient, which resulted in a uterine perforation. As a result of this perforation, the patient suffered a host of complications, including scarring, bleeding, and other damages that have negatively affected the patient’s fertility. It is alleged that the doctor’s initial failure to recognize the remaining placental tissue led, in turn, to the subsequent failures in the patient’s care.

Question(s) For Expert Witness

1. How do you ensure that all products of conception are evacuated?

2. Is there an increase risk of future complications?

3. Is the risk for ectopic pregnancies higher in the future?

Expert Witness Response E-007060

To ensure that all products of conception are evacuated it is necessary that, at the time of birth, the provider examines the placenta to make sure that all cotyledon are present. It is also important to take into account the degree of bleeding a woman has post-partum. Really, the entire clinical picture is assessed. There is an increased risk of future complications such as intrauterine infections and anovulation if all of these factors are not accounted for. The greatest risk of retained products is subinvolution, meaning that the uterus is unable to return to normal size via the process of contracting because of placental parts remaining inside. That will not affect future ovulation, however there are other complications to consider as well. Retained products could increase one's risk of intramaniotic infection which could have implications for future fertility. Scar tissue in the adnexa is probably the greatest risk factor for fertility issues, such as ectopic pregnancies, and the greatest risk of forming scar tissue in the adnexa is when women contract pelvic inflammatory infection. It is certainly reasonable that an infection of this nature, caused by the remaining placental tissue in this patient, could lead to complications with fertility down the road.