It is rare in medical malpractice cases that the cause of the death or the injuries is straightforward and easily identified. Often there are breaches in the standard of care but the breach didn’t necessarily cause or even contribute to the damages. In this case, the media reports that the cause of death was a retained placenta. The physician who delivered the baby may or may not have breached the standard of care. Even if he did breach he standard of care, that may not have had any effect on the outcome. The medical liability may be on the physicians who she followed up with, or it may have just been a tragedy that was unavoidable.
Placental retention can cause sepsis and hemorrhage and, if left untreated, can lead to the death of the mother. Post-partum hemorrhage is of concern in every delivery and should be monitored appropriately. However, it can be difficult to assess because there can be delayed hemorrhage starting between 24 hours and 12 weeks postpartum, and the hemorrhage may not be obvious. In cases of retained placenta, the hemorrhage typically begins within the first 24 hours of delivery and is known as primary hemorrhage.
Mothers always bleed postpartum as a normal part of healing and the hemorrhaging may be masked by the bleeding. The most common cause of postpartum hemorrhage is uterine atony and therefore fundal massage is done after every delivery. However, if the cause is not uterine atony, the other causes of hemorrhage need to be ruled out. Identifying that the hemorrhage exists may or may not be difficult; identifying the cause may be more difficult. Lab studies may not demonstrate a significant change and will not show abnormal values until after significant blood loss has occurred. This is also true of subjective findings such as dizziness, hypotension and pallor. Therefore, the patient may be discharged prior to exhibiting any signs or symptoms.
Once suspected, diagnosis of a retained placenta is done by ultrasound. This is a relatively inexpensive test and can be performed at the bedside, allowing for quick diagnosis in the emergency department or outpatient settings. The media report states that the mother retuned to the hospital twice. The fact that she returned twice to the hospital is a red flag in itself that something is wrong and further testing should have been performed at that time. If she demonstrated clear signs of sepsis (fever, hypotension, tachycardia) or hemorrhage (pallor, hypotension, dizziness) than a full assessment should have been completed.
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Works Cited:ACOG. (2012). Optimizing Protocols in Obstetrics: MANAGEMENT of OBSTETRIC HEMORRHAGE. ACOG.