subject: An Analysis Of Two Lawsuits Involving A Delay In Reacting To A Placental Abruption [print this page] A placental abruption is a serious complication that can arise late in pregnancy. There is no treatment for a placental abruption. It can cause serious injury to the baby or even result in a stillbirth. In certain cases it can also lead to the death of the mother. When a pregnant patient presents with symptoms that indicate the possibility of a placental abruption, doctors and nurses must either rule out the possibility of a placental abruption or take action immediately in order to protect the baby and the mother.
A placental abruption is often accompanied by heavy vaginal bleeding and by pain in the lower back and abdomen. Depending on where and how much of the placenta separates from the uterus, however, there may be no visible bleeding. Other symptoms that may indicate a placental abruption include a drop in the fetal heart rate as the unborn baby is deprived of oxygen, a change in blood pressure, and unusual contraction patterns. The following cases illustrate how doctors and nurses sometimes miss these symptoms
Case 1:
This case involved a lawsuit pursued by parents whose baby was born still. The mother had gone to see her obstetrician because of persistent vaginal bleeding. She also had both back and abdominal pain. She was 38 years old at the time. Her obstetrician sent her home without any diagnostic testing to explain her symptoms. By the following day she had to go to the hospital after experiencing massive bleeding.
While at the hospital the attending physician read the tracings from the fetal heart rate monitor as normal. Without any other testing, work up, or even ultrasound to determine the source of the bleeding, which continued along with the abdominal pain, the attending simply decided that she was not yet in labor and that it was fine to send her home. When the baby was finally delivered it became clear that the woman had suffered a placental abruption which was the cause of her bleeding and which in time took the baby's life. The parents filed a lawsuit. The case went to trial and the jury awarded $1.65 million, according to the report by the law firm that handled the case.
Case 2:
This case involved a series of errors by hospital staff that resulted in the stillbirth of a baby due to a placental abruption. First, upon admission she was noted to have high blood pressure during her initial examination. For the rest of the time the woman was in labor no other blood pressure readings were taken. Second, the woman experienced unusual contraction patterns but the labor and delivery nurse did not consider a placental abruption as the cause. Finally, the nurse did not make any effort to increase the IV fluid rate or to administer oxygen as resuscitative measures. A settlement in the amount of $300,000 was reported by the law firm that handled this matter.
Analysis:
In the first case above, the woman had the two main symptoms of placental abruption. By the time she reported to the hospital she experienced what was described as "massive" bleeding. The doctor, however, focused only on the fetal heart rate readings ignoring the danger that existed not only for the baby but for the mother who could go into shock or even die from the loss of blood.
The woman in the second case had a different presentation. She did not have the classic symptoms of a placental abruption but there were other signs that a complication had developed. High blood pressure at this stage of the pregnancy should raise suspicion that something may be wrong and trigger the close monitoring of the woman's blood pressure throughout the remainder of her labor. Taken in combination with the high blood pressure the unusual contraction patterns should also have raised concern. Yet, the nurse took no action and did not notify a physician of these signs.
When doctors and nurses fail to recognize that abnormal developments in a pregnancy may be the result of a serious complication and so not diagnosing that a placental abruption has occurred, do not performing an emergency C-section (or in the case of nurses not notifying a doctor), and that baby is born still as a result, those doctors and nurses may be liable for malpractice.
