Page 49 - OB Risks - Delivering the Goods (Part One)

SVMIC Obstetrics Risks: Delivering the Goods

a failure to document discussions of a known potential risk with

a patient despite multiple prenatal encounters can create an
insurmountable hurdle for the defense.

C A S E S T U DY

In this next case, a 31-year-old female presented to her

physician for regular prenatal care and during the third
trimester was determined to have a large baby. Because

of the patient’s history of a previous vaginal delivery of
a larger infant complicated by a shoulder dystocia and

a fourth-degree episiotomy laceration, the delivering
physician discussed the benefit of an elective C-section

for this delivery.

The mother, however, declined an elective C-section and
was induced for delivery which was again complicated
by a shoulder dystocia and once again required another

episiotomy resulting in a fourth-degree laceration. The

patient went on to have multiple emergency department
visits, physician consults, and treatments to evaluate
ongoing issues of abdominal pain, constipation, and stool

incontinence. Four years after the delivery, she underwent

a sphincteroplasty to attempt to resolve the incontinence
issues, but continuing complications impacted the
patient’s ability to participate in activities with her family,

resulting in depression requiring medical care.

The plaintiff filed a lawsuit alleging the physician “failed to
take appropriate steps to avoid the fourth-degree degree

perineal laceration.” Examination of the medical record
revealed the physician documented his knowledge of the

previous delivery and fourth-degree degree laceration, as

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