A dangerous diagnostic problem that arises with surprising frequency is the failure to properly diagnose non-obvious symptoms. This is an especially disturbing problem when it arises in the context of a pregnancy.
In particular, consider the complication known as a placental abruption. A placental abruption occurs when the placenta (which holds the unborn baby) prematurely separates from the mother's uterus. As this happens blood vessels are torn causing bleeding. The loss of blood means a loss of oxygen to the baby. And the loss of oxygen can lead to brain damage. In severe cases, the loss of blood can also jeopardize the life of the mother.
The classic signs of placental abruption include persistent severe back and abdominal pain and vaginal bleeding. Not all cases, however, present with vaginal bleeding as the blood can get trapped and thus not be visible. Thus, when the woman complains of persistent severe back or abdominal pain this should raise the suspicion of a possible placental abruption. In these cases certain blood tests, such as hematocrit and hemoglobin levels, can indicate whether there is internal bleeding. And an ultrasound may be able to show that pooled blood behind the placenta.
With this consider the case in which a pregnant woman was admitted to the hospital at 30 weeks into the pregnancy complaining of back pain and little, if any, fetal movement. A fetal heart rate monitor was read as showing normal tracings. The woman, however, continued complaining of severe back pain and an inability to urinate. Blood and urine tests were run two hours after her admission - all interpreted as negative, ruling out a kidney stone which the physician suspected was the cause of the symptoms.
It was not until six hours after her admission that an ultrasound was performed. The ultrasound showed that the woman had had a placental abruption that had left a large internal blood clot. At this point the physician performed an emergency C-section. By that time, however, the baby had experienced a loss of blood and oxygen to the brain resulting in brain damage. As a consequence, the child developed spastic quadriplegia.
The defense took the position that the C-section was performed at the earliest opportunity and that the hemorrhaging would have taken place even if different care had been provided. The law firm that handled this case took the case to trial and presented evidence that the physician should have performed the C-section after the results of the blood and urine tests were known - which the evidence suggested should have been read as indicating a possible placental abruption.
The evidence suggested that the physician focused on the wrong differential diagnosis (kidney stone rather than placental abruption) and having done so, failed to realize that the test results provided more information pointing to a placental abruption. Instead, the hemorrhaging from the placental abruption reached a grade 4 which involves substantial bleeding from the tearing of blood vessels as the placenta separates from the uterine lining. The law firm that handled the matter reported that the defense settled for $2.5 million. The child was 2 years old at the time of the settlement.
As this case illustrates it is not enough for a physician to rule out a particular diagnosis as the cause of symptoms displayed by a pregnant patient. The physician still needs to account for the symptoms. And the failure to do so, even when presented with multiple sources of information consistent with a dangerous complication, can result in permanent harm to the baby. When this happens the physician may be liable for medical malpractice.
Author Resource:-
Joseph Hernandez is an Attorney focused on complex injury cases, including birth injury medical malpractice cases. You can learn more about Placental Abruption and Medical Malpractice Cases at his website www.birth-injury-malpractice-law.com.
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