Intact Placenta Leads to Post-Partum Complications

Case Summary

The patient (mid-20s) had a past medical history notable for asthma, depression, and a prior ectopic pregnancy. In this matter, she underwent a vaginal delivery in February 2013 for her second child. However, all of products of conception reportedly did not get discharged, although the medical records indicated that they were. The patient ended up at another hospital after two weeks of bleeding and discomfort, as she believed the initial hospital was “blowing her off”. She had two separate D&C (Dilation and Curettage) surgeries to deal with the complications from this delivery including heavy bleeding and pelvic discomfort. During this procedure, her uterus was also punctured. The patient is no longer able to have children and subsequently had her tubes tied.

Questions

Did the OB staff at the initial hospital breach the applicable standard of care? If yes, did it lead to the patient’s post-partum complications?

Expert Findings

AMFS expert (Perinatology) reviewed this case matter and provided the following opinion:  Review of the patient’s medical records demonstrate that standard of care was not met in terms of a delayed diagnosis. If the patient had had a physical exam in a timely manner (with regard to her increased vaginal bleeding and discomfort), or if there had been an ultrasound assessment (placenta appeared abnormal), she may have been diagnosed with retained products of conception sooner. An earlier diagnosis may have resulted in a less morbid surgical procedure. The complications from the surgery to remove the products of conception are known complications of the procedure. Dilatation and curettage for retained products of conception after a delivery involves a high risk of uterine perforation and attendant bowel and bladder injury.