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High Risk Obstetrics Expert Witness

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High risk pregnancy is any form of pregnancy in which the unborn fetus or the mother are in danger. Common high risk pregnancies are ectopic pregnancy or premature delivery. Pregnant women should frequently visit their doctors (OB/GYNs) in order to ensure that the risk of these pregnancies is minimal. OB/GYNs should pay attention to signs that indicate these conditions.

Two of AME's high risk obstetrics expert witnesses have written exclusive medical malpractice articles that we have provided, for your interest, below.


Experts Recommended for Maximizing Recovery In Obstetrical Cases


Obstetrician: Whether or not the defendant is a general practitioner or an obstetrician, the standard of care is that of an obstetrician. That expert will testify to the proper standards of care, which were in effect at the time at that size hospital. He will discuss departures from the proper standard of care, if any, on the part of the doctor, nurses, and the hospital. In addition, many obstetricians would be comfortable in testifying to proximate causation. However, the proximate causation question is best handled by a pediatrician and/or pediatric neurologist.

Pediatrician and/or Pediatric Neurologist: When there is brain damage to the baby, it is important to ascertain the cause. Pre-delivery factors such as infections, hemorrhage within the brain and genetic and other congenital causes unrelated to negligence must be ruled out. The strongest obstetrical malpractice cases are sometime lost because of the "so what" defense.

These experts could also testify to the negligent delivery, with the low Apgar score as the proximate causation of the brain damage (cerebral palsy and/or mental retardation), and could rule out post-delivery causes such as a very low blood sugar, or pediatric or pediatric nursing negligence in failing to adequately suction the baby's throat and maintain adequate oxygenization. When there are potential multiple insults to the child, they can testify with regard to which ones were substantial contributing factors to the brain damage.

Obstetrical Nurse: The obstetrical nurses are independent personnel who have their own duty to their patient, your client. They are in a position to determine whether or not proper care is being given, and to obtain professional assistance in a timely manner via the chain of command which must be established by every hospital. These nurses are also seeing the patient on an on-going basis and are reviewing the fetal monitor. If there is any evidence of fetal distress or lack of progression of labor, the obstetrician must be notified promptly. The nurses can place the patient on her side to minimize the negative effects of the uterine pressure and contractions on uterine blood flow in the presence of fetal distress, but they also must obtain prompt obstetrical medical assistance.

The nurses will perform sterile vaginal examinations periodically, check the fetal heart rate themselves, and, when an external fetal monitor is being used, position the transducer on the mother's abdomen to get the best recording of the fetal heart beat. They have a duty to record, in their nurses' Labor Room notes, what is happening to the patient and to act promptly upon any "red flags" which may arise.

Radiologist: When there is a question of cephalopelvic disproportion and pelvimetry x-rays were taken, a radiologist can comment upon what the proper interpretation should have been and how that information should be communicated to the attending obstetrician.

Hospital Administrator: He can best express the failures of the hospital to establish protocols and procedures required by the Joint Commission on Accreditation of Hospitals (JCAH) and how those failures caused or increased the risk of injury to the plaintiff. He can also discuss physician credentialing failures, nurse training failures and equipment inspection failures.

Psycho-Neurologist: This expert is a Ph.D. who specializes in sophisticated testing of all parts of the brain to detect and quantify all damages. Such damages include motor skills; intellectual functioning such as basic mathematical, reading, understanding, communicating and reasoning skills; sensory skills of vision, hearing, smell, taste and feel; memory; thought processes; and the patient’s response to any defects. Based on the dysfunction found, causation, permanency and special education needs can also be discussed.

Forensic Psychologist: This expert can administer the objective psychological tests to determine the full extent of emotional damage and emotional dysfunction of the child. They can testify as to what such a damaged child would perceive their injury to be as they age, and how that would affect them further. The psychologist can examine and test the family as well.

Forensic Psychiatrist: This expert will continue the psychiatric evaluation as a physician, and both he and the clinical psychologist will then "cry to the jury", for the anguish of the child and family.

Occupational/Disability Expert: This expert will discuss the physical and mental limitations of the patient from a physician's aspect, and explain how those disabilities would substantially interfere in job performance in the future (and, therefore, limit income) and how they will interfere in normal daily living, thereby increasing the psychological damages. These experts can also discuss the need for remedial and corrective operations, if indicated. The related costs and pain and suffering from such corrective surgery and care can best be expressed to the jury by this type of expert.

Employability Expert: This is a Ph.D. (not a physician) who can discuss what such a patient, if mentally intact, would have been able to earn, based upon a high school education, and normal physical condition in his city and job market versus what limitations are now imposed and based upon the disability as documented by the previously mentioned physician and Ph.D. experts.

Economist: This expert will place the dollars and cents before the jury, based upon loss of income from diminished earning capability, as testified to by the employability expert and disability experts. This, in conjunction with the cost of future medical care as testified to by the pediatrician and occupational medicine/disability experts and other physicians can clarify the economic issues (as established by your state statutes and case law) to the jury.


Missed Diagnosis of Pre-Eclampsia


If the patient starts out her pregnancy with 130/70 blood pressure and the 70 changes to 80, it must be looked at, not necessarily treated, but looked at. If the 80 goes up to 85, then you have to be concerned about the possibility of early pre-eclampsia, a high blood pressure condition in pregnancy which can cause damage to the mother and the baby. When there is high blood pressure in the mother, blood flow to the placenta, which nourishes the baby, is impaired and there is a higher risk of the placenta separating from the lining of the uterus (abruptio placenta).

Patients suspected of having possible pre-eclampsia are also given urine tests. Protein appear in the urine abnormally; we call it "spill out".

Actually, the protein leaks through the filtering system of the mother's kidneys into the urine. The mother's kidneys filter her blood to remove her impurities and those she absorbs into her blood from the baby through the placenta. With high blood pressure, the filtering mechanism is damaged.

In pre-eclampsia, protein which is in the blood and which should stay in the blood and not go in the urine will go into the mother's urine where it can be picked up with these simple, inexpensive tests. It's standard to check the urine for protein at every obstetrical visit. If any protein is found and if the level of protein in the urine rises, and/or if the blood pressure is rising, the doctor must be concerned about pre-eclampsia.

Reflexes (knee jerk, ankle, elbow) are tested at each office visit. In pre-eclampsia, these responses become more active (brisker) and are another indicator of potential problems.

If the blood pressure starts rising, the woman must be placed at absolute bedrest (other than going to the bathroom) and a low salt diet prescribed to treat and prevent progression of pre-eclampsia. Often this works. If that doesn't work, then you give the mother tranquilizing medications such as the barbiturate Phenobarbital or a sedative. If that doesn't work, you begin some of the mild antihypertensive agents which reduce blood pressure.

If this office and home treatment for pre-eclampaia is ineffective, the woman must be hospitalized quickly. This is a clinical judgment; however, it can also be poor judgment, which is negligence. If the diastolic pressure starts to rise to 90 or 95, then she must be hospitalized, regardless of the week of pregnancy. She must be kept in a hospital environment, under treatment, so the blood pressure stays down in a range safe enough to protect the mother and baby. Then the mother can carry the baby as close to term as possible; as close to the forty weeks the baby would normally go. If the blood pressure continues to rise however, at that point the obstetrician must intervene to deliver the baby. This can be done either by induction with the hormone-like medication Pitocin which stimulates the uterus to contract down so the mother can deliver the baby vaginally or, if that's not successful, and the blood pressure continues to rise, then by a Caesarean section operation.

The mother is given either general or spinal anesthesia which paralyzes and numbs the abdominal muscles. The abdomen is cut and opened between the umbilicus (the belly button) and the pubic bone. The bladder is separated from the lower third of the uterus. The uterus is opened, the baby taken out and the placenta (afterbirth) removed.

Then everything is sewn back up again. The only definitive treatment for pre-eclampsia is to deliver the baby without delay.






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