subject: Placental Abruption At 30 Weeks Of Pregnancy Ends In Babys Brain Injury [print this page] A dangerous diagnostic predicament that comes up with surprising frequency is the failure to correctly diagnose non-specific symptoms. This is a particularly troublesome matter if it occurs in the context of a pregnancy.
For example, consider the complication referred to as a placental abruption. A placental abruption happens when the placenta (which holds the unborn child) detaches from the mothers uterus prematurely. When this happens blood vessels are ripped inducing bleeding. The loss of blood translates to a loss of oxygen to the unborn child. In addition the loss of oxygen can cause brain damage. In extreme cases, the loss of blood can also jeopardize the life of the woman.
Two frequently occurring symptoms of a placental abruption are bleeding and extreme pain in the abdomen or lower back. Not all situations, however, have vaginal bleeding since the blood can get trapped and hence not be visible. Due to this fact, when a woman complains of persistent severe back or abdominal pain this ought to heighten the suspicion of a potential placental abruption. Blood tests can enable medical professionals to see if the woman is bleeding internally even though there is no visible blood. In addition an ultrasound may be able to show that pooled blood behind the placenta.
Consider the following situation regarding the admission to a hospital of an expectant mother. She was in her thirtieth week of the pregnancy. She had back pain. She reported only minor or no fetal movement. A fetal heart rate monitor was read as showing normal tracings. The woman, however, kept complaining of severe back pain and was not able urinate. The staff thought she might have a kidney stone and so performed tests to assess whether this was the reason for her symptoms. Still this did not occurr until some 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 expectant mother had experienced a placental abruption that had left a large internal blood clot. At this point the doctor did an emergency C-section. Unfortunately, the baby had sustained a loss of blood and oxygen to the brain leading to brain damage. Because of this, the child developed spastic quadriplegia.
The defense took the position that the C-section was performed at the earliest chance and that the hemorrhaging would have taken place 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 done the C-section as soon as the results of the blood and urine tests were available - as the evidence suggested should have been read as showing a likely placental abruption.
The evidence suggested that the physician focused on the wrong differential diagnosis (kidney stone and not placental abruption) and having done so, did not grasp that the test results furnished additional information pointing to a placental abruption. Rather, the hemorrhaging from the placental abruption reached a grade 4 which includes substantial bleeding because of the tearing of blood vessels as the placenta separates from the uterine lining. The law firm that handled the case documented that it for $2.5 million. The recovery was achieved when the child was two.
As this incident shows it is not sufficient for a physician to rule out a given diagnosis as the cause of symptoms exhibited by an expectant mother. The doctor still should account for the indications. Not doing so, even if given various sources of information consistent with a high risk complication, may result in permanent harm to the baby. In the event that this happens the doctor may face a malpractice lawsuit.
by: Joseph Hernandez
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