Florida – Obstetrics – Postpartum Bleeding Following Early Labor In A Patient With A History Of Anemia

On 9/7/2012 at 8:00 p.m., a 27-year-old female presented to a medical center with a complaint of early labor.  The patient had a history of anemia.

At 8:50 p.m., a biophysical profile was ordered for the patient due to heart tracing concerns for the fetus.

By the time the patient arrived back from her biophysical profile, she was found to have made cervical changes from 1-½ cm to 4 cm, and she then very rapidly went from 4 cm to 9 cm.

At 11:15 p.m., the patient’s membranes were artificially ruptured and meconium stained fluid was obtained.  At this time, the cervix was now completely dilated.

At 11:55 p.m., an obstetrician applied a fetal scalp lead to better evaluate the monitor tracing.

At 12:15 a.m., the obstetrician then called in additional medical personnel and proceeded to apply a Kiwi vacuum extractor.

At 12:17 a.m., a second vacuum was applied and at 12:27 a.m. a third vacuum was applied.

At 12:27 a.m., the fetus was delivered with the baby weight 9 pounds and 8 ounces

The patient then experienced a severe postpartum hemorrhage, and the obstetrician inspected the cervix and found there to be no lacerations.  The obstetrician used appropriate medications to cause the uterus to clamp down.

At 12:45 a.m., the obstetrician repaired episiotomy and third-degree perineal laceration, and the uterus was still boggy in spite of the medications. The bleeding continued.

At 1:00 a.m., the uterus was described as firm, the bleeding had decreased and the patient was sleepy but responsive.

At 1:15 a.m., the patient had a steady trickle of lochia resulting in the obstetrician being called back into the room.

At 1:20 a.m., the obstetrician performed a repair of laceration.

At 1:25 a.m., the patient was administered a Foley catheter per the obstetrician’s instructions.

At 1:35 a.m., following repair of the laceration, the patient was bleeding dark blood vaginally.  Additionally, the patient was hypotensive and lethargic.

Sometime after 1:35 a.m. but before 2:10 a.m., the obstetrician left the hospital.

At 2:00 a.m., the patient continued to bleed vaginally, small to moderately.

At 2:10 a.m., the patient’s family called medical staff to the room due to the patient “acting funny” as the patient was lying on her stomach and moving her legs and moaning that she was hurting but would not say where.

At 2:10 a.m., the patient was noted to have bloody fluid in the Foley catheter.

The obstetrician was not present in the hospital at the time.  The obstetrician was informed of the patient’s behavior and the continuation of her steady trickle of blood.

At 2:25 a.m., a registered nurse stayed in the room with the patient as the patient became more combative and a large amount of blood poured from the patient’s vagina.

At 2:25 a.m., the obstetrician was called to return to the hospital.

At an unidentified time, the obstetrician was called again to ensure she was on her way back to the hospital.

At 2:55 a.m., the obstetrician arrived back in the hospital room with the patient.

At 3:14 a.m., the patient became unresponsive and a code blue was called.  The patient experienced cardiac arrest and cardiopulmonary resuscitation was started.

At 6:03 a.m., the patient was pronounced dead.

The Medical Board of Florida judged the obstetricians conduct to be below the minimal standard of competence given that she failed to determine the source of the bleeding for the patient who had been bleeding heavily after a vaginal delivery.  The obstetrician failed to transfer the patient to the operating room for evaluation. She also failed to remain at the physical location of the hospital to monitor the patient who had been bleeding continuously.

It was requested that the Medical Board of Florida order one or more of the following penalties for the obstetrician: permanent revocation or suspension of her license, restriction of practice, imposition of an administrative fine, issuance of a reprimand, probation, corrective action, payment of fees, remedial education, and/or any other relief that the Medical Board of Florida deemed appropriate.

State: Florida

Date: February 2017

Specialty: Obstetrics

Symptom: Abnormal Vaginal Bleeding

Diagnosis: Obstetrical Hemorrhage

Medical Error: Underestimation of likelihood or severity, Failure to examine or evaluate patient properly, Failure to properly monitor patient

Significant Outcome: Death

Case Rating: 4

Link to Original Case File: Download PDF

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