Child Left With Spastic Quadriplegia Due To Misdiagnosis Of Placental Abruption

A high risk diagnostic problem that arises with surprising frequency is the failure to correctly diagnose non-specific symptoms. This is a particularly troublesome problem if it comes up in the context of a pregnancy.

In particular, consider the complication known as a placental abruption. A placental abruption happens when the placenta (which holds the unborn child) detaches from the mother’s uterus prematurely. When this takes place blood vessels are torn resulting in bleeding. The loss of blood leads to a loss of oxygen to the baby. And the loss of oxygen can cause brain damage. In severe situations, the loss of blood can further jeopardize the life of the woman.

The classic signs of placental abruption consists of persistent severe back and abdominal pain as well as vaginal bleeding. Not all situations, however, have vaginal bleeding as the blood can get trapped and thus not be observable. Due to this fact, when a woman tells a medical professional about persistent considerable back or abdominal pain this should raise the suspicion of a potential placental abruption. In these circumstances certain blood tests, like hematocrit and hemoglobin levels, may indicate whether there is internal bleeding. And an ultrasound may be able to show that pooled blood behind the placenta.

With the above look at the case in which a pregnant woman was admitted to the hospital at 30 weeks into the pregnancy with back pain and little, if any, fetal movement. The staff connected her to a fetal heart rate monitor and concluded that the results were normal. The expectant mother, though, kept reporting that she had major back pain and was not able urinate. The staff considered the posibility that she might have a kidney stone and thereby ordered tests to assess whether this was the reason for her symptoms. Still this did not occurr until approximately 2 hours after she had been admitted.

It was not until six hours after her admission that an ultrasound was done. The ultrasound found that the woman had experienced a placental abruption that had left a large internal blood clot. Next the doctor finally performed an emergency C-section. Given the delay in recognizing the abruption, the unborn child's blood and oxygen supply had been severely restricted for an extended period of time, bringing about brain damage resulting in a form of cerebral palsy.

The defense took the position that the C-section was performed at the first opportunity and that the hemorrhaging would have happened even if different care had been given. The law firm that handled this lawsuit took the case to trial and introduced evidence that the physician should have carried out the C-section as soon as the results of the blood and urine tests were known - which the evidence indicated should have been interpreted as revealing a possible placental abruption.

The evidence suggested that the physician concentrated on the wrong differential diagnosis (kidney stone rather than placental abruption) and having done so, failed to realize that the test results provided further information pointing to a placental abruption. Rather, the hemorrhaging from the placental abruption reached a grade 4 which involves excessive bleeding from the tearing of blood vessels as the placenta separates from the uterine lining. The law firm that handled the case announced that the defense settled for $2.5 million. The child was 2 years old at the time of the settlement.

As this incident demonstrates it is not enough for a physician to rule out a particular diagnosis as the explanation for symptoms displayed by a pregnant patient. The physician also ought to take into account the indications. Not doing so, even when presented with several sources of information consistent with a high risk problem, may result in permanent harm to the baby. In cases where this occurs the doctor might be liable for medical malpractice.