Obstetrics Expert Discusses Patient Death From Retained Products of Conception

This case involves a woman who vaginally delivered a her fifth child without complications during active labor. The patient’s husband observed the doctor tear the umbilical cord during the final stage of labor. The following day, nursing staff as well as visitors reported that a strange smell was emanating from the patient’s room, however the lead nurse claimed that the smell was normal and that it would subside in time. Eventually the patient was discharged from the hospital, however the smell persisted. Shortly after being discharged from the hospital, the patient noticed that her fingertips had begun to turn white, was unable to stand, and felt unusually cold. The patient returned to the hospital where she gave birth, where doctors discovered and removed multiple pieces of retained placenta. The patient was then rushed to emergency surgery, however doctors could not save her life. The cause of death was listed as infection from retained products of conception.

Question(s) For Expert Witness

Expert Witness Response E-008110

I routinely perform obstetrical care, including inpatient obstetrics, and have managed the obstetrical complication of retained placenta. What is less critical than the umbilical cord tearing in this case is (1) whether the placenta had to be manually removed after the umbilical cord tore, and (2) if the placenta was carefully inspected after delivery. If manual extraction occurred, then the patient should have received a formal ultrasound after delivery. If the placenta was not carefully inspected with adequate documentation then standard of care was not met. I would also focus on the care quality during the readmission and whether signs of sepsis were appreciated in a timely manner. The care received during the re-hospitalization may be more important in determining whether standard of care was met than the initial delivery events.

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