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Plaintiff, age 38, underwent an elective Caesarean section on Nov. 13, 2009. Her prenatal course had been complicated by gestational diabetes and concern regarding placental location. The defendant OB/GYN practice and an OB/GYN from the practice (not a defendant to the action), had treated plaintiff throughout the pregnancy and through ultrasound had diagnosed an anterior low placenta and possible posterior succenturiate lobe. The OB/GYN had referred plaintiff to maternal-fetal medicine, where it was determined through ultrasound that plaintiff had an anterior partial placenta previa and maternal vessels crossing the internal os. MFM had recommended that plaintiff be managed as a placenta previa patient. A subsequent ultrasound by MFM revealed an anterior placenta that extended to the left lateral wall and maternal vessels crossing the os that would cause bleeding with dilatation. MFM again recommended that plaintiff be managed as a placenta previa patient and have an additional ultrasound prior to delivery. The final ultrasound revealed an anterior low-lying placenta and MFM recommended that plaintiff be managed as a previa patient with delivery by C-section.
The C-section was scheduled for Nov. 13, 2009, by the non-defendant OB/GYN. Due to Hurricane Ida, the OB/GYN was unable to leave her neighborhood to come to the hospital and requested that another physician from the defendant OB/GYN group, who was on call and at the hospital, perform the C-section. The non-defendant OB/GYN gave report to the defendant OB/GYN, who then reviewed the plaintiff’s entire office chart including imaging, records and ultrasound reports from MFM, and then spoke with the plaintiff, who gave her informed consent to proceeding with the C-section as scheduled.
During the C-section, the defendant OB/GYN performed a transverse low incision in the lower uterine segment. In doing so, the defendant disrupted and entered a small portion of the placenta, consistent with an anterior previa, to deliver the infant. The infant’s arterial and venous cord blood gasses at birth were normal. Blood gasses drawn approximately 40 minutes later in the nursery were abnormal and the infant was transferred to a NICU at another facility where the infant was diagnosed with anemia and other medical issues. The infant fully recovered and was discharged after 31 days, with the anemia and all other medical issues resolved halfway through the NICU stay. The infant had no neurological or developmental deficits from the birth and subsequent hospitalization in the NICU.
The plaintiff’s diagnostic radiology expert, who admitted that she had never located an incision site for an OB/GYN to perform a C-section, testified that an ultrasound from MFM taken approximately five weeks prior to delivery demonstrated a “clear field” for a surgeon to perform the Caesarean delivery without disrupting the placenta. Plaintiff’s OB/GYN expert claimed that the defendant OB/GYN should have performed a classical vertical uterine incision to avoid the placenta.
The defense experts testified that the ultrasound films from MFM were not available to the defendant OB/GYN and the standard of care did not require the defendant to obtain them prior to performing the C-section. They further testified that a classical vertical uterine incision would have been likely to disturb more of the placenta. Defendants’ expert witnesses testified the physician complied with the standard of care in all respects in performing a transverse low incision in the lower uterine segment. They testified that blood loss during a C-section is a known risk and complication of a C-section and this risk is increased in a patient with an anterior placenta as it can involve going through the placenta to accomplish the delivery. The defendants’ experts testified that the OB/GYN’s incision location and operative technique to accomplish the delivery of the infant was appropriate and complied with the standard of care in all respects. They further testified that the defendant OB/GYN delivered the infant with normal cord blood gasses.
On the third day of trial, the jury returned a verdict in favor of the defendants.
[15-T-100]Type of action: Medical malpractice
Injuries alleged: Placental disruption during Cesarean section
Court: Norfolk Circuit Court
Tried before: Jury
Judge: John R. Doyle III
Date resolved: July 15, 2015
Demand: $3,000,000
Offer: None
Verdict or settlement: Defense verdict
Attorneys for defendant: Kimberly A. Satterwhite and Sandra Morris Holleran, Richmond
Insurance carrier: MAG Mutual Insurance Company
