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Failure to Diagnose Preeclampsia - The Duffner Case

Filed under Birth Injury, Stillbirth

The Duffner Case

This was the mother’s third pregnancy. Her prior pregnancies had been complicated by intrapartum and postpartum preeclampsia, also known as toxemia or pregnancy-induced hypertension. In her 36th and 37th weeks of pregnancy (40 weeks is full term), she consulted with her obstetrician with complaints of pre-term labor. Ultrasounds and vaginal examinations revealed that she was dilating. She had elevated blood pressure and protein in her urine. During pregnancy, high blood pressure in combination with urine protein is an ominous sign of impending preeclampsia. Nevertheless, the obstetrician sent her home with instructions to lie on her left side, monitor her own blood pressure frequently, report any elevations in blood pressure and to report any absence of fetal activity.

The day after the second late-term ultrasound, the mother reported more frequent contractions and elevated blood pressure. She asked to be admitted to the hospital. Her obstetrician discouraged her from going to the hospital, but the mother talked it over with her husband and again called asking to be admitted. The obstetrician relented and allowed her to come in. Upon examination, the nurses had difficulty picking up the fetal heartbeat on the fetal heart monitor and called the obstetrician to examine the mother. He refused. Continued monitoring by the nurses showed no sign of any fetal heart beat and there were no residents or physicians available to examine the mother. After considerable time, a perinatology fellow performed an examination and again was unable to document a fetal heartbeat. The obstetrician was called again, but once more he declined to come in because he was seeing other patients. When he finally came to examine the mother, he confirmed that her baby had died in the uterus and he advised the parents against having an autopsy. Labor was finally chemically induced. The stillborn boy weighed 8 pounds, 8 ounces. It was later determined that the baby had been healthy until several hours prior to delivery.

Suit was filed in Allegheny County against th obstetrician and the hospital. Over the course of the lawsuit, hospital documents were discovered which encouraged obstetricians to refrain from having their patients admitted “too early” for fetal monitoring because this practice lead to “avoidable” costs of “unnecessary” hospital days and “unnecessary” Cesarean sections. Shortly before trial, Harry S. Cohen & Associates negotiated a very substantial settlement.