VBAC Uterine Rupture Lawsuit

Strautin v. University of Maryland St. Joseph Medical Center

CT ScanThis medical malpractice claim was filed in Baltimore County after a woman's uterine rupture went undiagnosed. It was filed in Health Claims Arbitration on February 16, 2018, and it is the 82nd medical malpractice case filed in Maryland this year.

Summary of Plaintiff's Allegations

A 32-year-old woman presented to the hospital at 39 weeks pregnant and in labor. She'd had one prior baby via C-section, and delivered her newborn vaginally. While delivering her baby, the woman experienced a perineal laceration which was repaired while she was under the epidural anesthesia.

While receiving postpartum care at the hospital, the woman began to feel pain in her ribs and was administered Ibuprofen. The pain medication provided no relief, so the hospital personnel provided an ice pack and prescribed one Percocet every four hours. The woman's symptoms continued to worsen in spite of the narcotics. She reported that her chest pain increased with movement and that it hurt to breathe. An EKG, chest x-ray, and cardiac enzymes ruled out any cardiac issues.

Several hours later, the woman complained of chest pain radiating from to her neck and shoulders. Hospital personnel incorrectly attributed her symptoms to a muscular source and continued to administer Percocet, ice, and massage to the shoulders and neck. By the next morning, the woman reported severe pain and spasms in her upper back, neck, chest, and abdomen. After a physical examination, the woman was diagnosed with muscle strains and was encouraged to continue taking Percocet with heat, stretching, and ice. The woman was also given Simethicone, a medication used to treat gas, and discharged from the hospital later that day.

When the woman presented for her postpartum follow-up visit the next week, she complained of increased pain in the vaginal area, a change in bleeding, significant pain, burning with urination, and a strong vaginal odor. During the physical evaluation, the woman was visibly distressed, wincing with pain, and had a dark greenish-brown tissue at the vaginal floor. The doctor ordered a urinalysis and genital culture, prescribed Nitrofurantoin and Percocet, and instructed the woman to use sitz baths and return for a follow-up in two days. Contrary to the standards of care, the doctor did not order any abdominal imaging. At the follow-up appointment, the doctor again failed to order abdominal imaging or any other diagnostic tests.

One week later, the woman returned to the hospital complaining of fever, chills, difficulty breathing, and abdominal pain. She was found to be septic, and an abdominal CT scan was finally performed. The CT images showed multiple intra-abdominal abscesses. The woman underwent a procedure to place drains in the two largest abscesses and she was started on antibiotic medications for her infection. Despite the interventions, the woman's white blood cell count continued to trend upwards. Three days later, the woman had an incision and drainage procedure for one of her abscesses.

Because her infection diagnosis had been delayed, the woman also had to undergo an exploratory laparotomy, abdominal washout, hysterectomy, and appendectomy. When the surgeon entered the woman's abdomen, her cervix was found to be necrotic, her uterus was sticking to the bowel, and her fallopian tubes and appendix were inflamed. This significant damage and infection could have been avoided if the woman's doctors had recognized and treated her uterine rupture sooner.

Additional Comments
  • The woman in this medical malpractice claim presented to the hospital for a VBAC - vaginal birth after cesarean. Having a vaginal birth after a prior C-section birth might be appealing because it has a quicker recovery time than a repeat C-section, but it also poses certain risks. Women who have a VBAC are more likely to suffer a uterine rupture, uterine dehiscence, and/or infection. Any physician who delivers a baby via VBAC should be prepared to handle these possible complications.

  • According to the claimant's expert witness, an OB/GYN physician, hospital staff breached the accepted standards of care by failing to order an abdominal CT scan once the woman began to complain of chest pain after a vaginal birth. As a result, the woman developed an infection that was allowed to fester, untreated, for approximately thirteen days. If an abdominal CT scan had been performed immediately after the woman's initial complaints, the expert believes that the CT images would have shown air in the endometrium and the woman would have been timely diagnosed with a uterine dehiscence.

  • The terms "uterine rupture" and "uterine dehiscence" are sometimes used interchangeably, even though they have slightly different meanings. There are two types of uterine rupture: complete or incomplete, depending on the severity of peritoneal damage. Incomplete ruptures are commonly referred to as uterine dehiscence and tend to occur along a surgical incision (in this case, the C-section scar).

Jurisdiction Defendants
  • University of Maryland St. Joseph Medical Center, LLC
Hospitals Where Patient was Treated
  • St. Joseph's Hospital
Negligence
  • Failing to carefully and thoroughly evaluate the claimant's condition.
  • Failing to properly interpret the effects and results of any tests, treatments, and procedures performed.
  • Failing to adjust the claimant's treatment in response to appropriate evaluation.
  • Failing to adequately monitor the course of the claimant's condition and treatment.
  • Failing to employ proper diagnostic procedures and tests.
  • Failing to diagnose the claimant's condition.
Specific Counts Pled
  • As a direct result of the defendant's negligence, the claimant suffered physical pain, emotional anguish, and severe disability. The defendant's negligence caused so much damage to the reproductive organs that they had to be removed, making it impossible for the claimant to bear any more children.

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