subject: Did Physician Miss Obvious Signs Of A Placental Abruption? [print this page] If you were to ask people how physicians diagnose a person's condition most people would probably say that physicians (1) consider the person's history and all the symptoms the person may be showing to (2) come up with the list of all possible causes that would explain them and then (3) conduct appropriate tests to eliminate all but the actual cause. But consider what happened in the following case.
An attending physician admitted a pregnant woman with massive vaginal hemorrhaging to the hospital. On taking the history of the 38 year old woman the physician found out that the woman had been seen the previous day with persistent bleeding and with back and abdominal pain. The physician used a fetal heart rate monitor to check the unborn baby's heart rate. On examining the strip the physician read it as normal and reassuring.
The physician concluded that the woman was not in labor. Having reached that conclusion he sent her home. Even though the woman continued to experience vaginal bleeding and to report continuing abdominal pain, the physician did not order an ultrasound or order a full workup to determine the cause of the bleeding and the pain. It later turned out that the source of the pain and bleeding was a placental abruption.
A placental abruption, often accompanied by vaginal bleeding as well as abdominal and back pain, is a condition in which the placenta prematurely separates from the wall of the uterus. The tearing of the blood vessels that occurs when this happens can cause the baby to lose vital nutrients and oxygen. If there is only minor tearing it may be possible to manage the condition. However, since there is no treatment that can cure a placental abruption, it is often necessary to take immediate action, such as an emergency C-section, to protect the baby from suffering severe brain damage or even death.
In this case, given the resulting loss of blood, nutrients and oxygen, the baby was born still. The law firm that handled the matter reported that the case went to trial where a jury returned a verdict of $1,651,166.
As this case illustrates it is almost as if, once the physician interpreted the fetal heart rate tracings as reassuring, the physician became committed to one train of thought: everything was fine with the pregnancy. Even the pain and bleeding, signs that something serious (including a placental abruption) could be wrong with the pregnancy, were not enough to derail that train of thought. And ordering an ultrasound or a work up would mean acting in a way that was not consistent with an uneventful pregnancy.
This type of error is very difficult to correct. Once a physician locks in on an interpretation all evidence is viewed through that interpretation. Anything inconsistent with the interpretation, rather than calling the interpretation into question, is viewed in a way that either minimizes it or makes it fit the interpretation. In situations such as these only the most extreme change in the patient's condition will trigger a re-interpretation consistent with the sings of complication.
At trial the jury essentially found that by not following up on the signs that suggested a potential placental abruption, the physician allowed a complication to continue which eventually took the life of the unborn baby. In this case a jury reached the conclusion that the physician committed medical malpractice. And as the law firm that handled the case reported, given the nature of the harm, the resulting award was substantial.
