Perinatology Expert Witness Discusses Failure to Monitor Pregnancy Complications

This case involves a 30-year-old pregnant female from Hawaii. The patient called her obstetrician when 30 weeks pregnant, complaining of cramping and discomfort that was associated with a fluid discharge. The physician assured her that it was most likely due to urinary leakage and that she did not need to come into the office for an exam. One week later the problem became worse which prompted the patient to seek treatment at a hospital. The hospital staff ordered an amniotic fluid test but did not perform a vaginal exam with the exception of a vaginal swab. The hospital physicians spoke with the patient’s OB-GYN who said the patient should be discharged home. The amniotic fluid test was not positive, but the physicians did note the suspicious presence of more than the normal amount of amniotic fluid. When the patient returned home she felt intense abdominal pressure that she assumed was an impending bowel movement. The patient went to the bathroom when she felt a baby’s foot in the vaginal canal. The patient was rushed back to the hospital and an emergent C-section was performed. The baby was found to have an Apgar score of 1, necessitating resuscitation measures. The baby was eventually stabilized but not after prolonged hypoxia. The baby was diagnosed with hypoxic encephalopathy and died from sepsis two weeks after birth.

Question(s) For Expert Witness

1. Should the hospital have taken this patient’s complaints and symptoms more seriously? 2. Should this patient have been discharged? 3. What are your initial thoughts?

Expert Witness Response E-005991

There were clearly a number of departures in this case. The patient was not thoroughly evaluated for preterm prom or for premature labor on multiple occasions, and as a result had an extramural delivery of a premature hypoxic baby. There was a failure to evaluate, monitor, and assess, which led to the unfortunate outcome here. It is vital that all patients are closely monitored during pregnancy, and the fact that this patient was not seen by an OB-GYN directly despite her ongoing complaints is very unusual.