This case involves a first-time mother who experienced a traumatic delivery after her doctors failed to address her breech presentation before delivery. The patient had presented to her treating obstetrician late in her third trimester of pregnancy complaining of cramps. The doctor then performed a vaginal exam as well as an ultrasound, which revealed that the patient’s baby was in the breech position and that the patient was dilated by several centimeters. Nevertheless, the patient was not immediately admitted to the hospital, but rather sent home by her obstetrician. The patient was urgently taken back to the hospital the following morning, when it became clear that she was in labor. The patient experienced a traumatic vaginal delivery, during which she suffered significant injuries to her uterus as well as her perineum.
Question(s) For Expert Witness
- 1. Do you have extensive experience treating similar patients?
- 2. What steps should be taken for a patient that presents with a known breech and is dilated?
Expert Witness Response E-000171
I have extensive experience with similar patients. I trained in an era when breech vaginal deliveries were the accepted norm. Consequently, I know how to do them, and actually perform the occasional vaginal breech today, when the circumstances are optimal. However, for most breeches, I recommend either external cephalic version or cesarean section in accord with current standards. Under normal circumstances, I would do an ultrasound to determine the type of breech (frank, complete, or footling), and the degree of flexion of the head, as labor and delivery has different implications for each. I would assess the likelihood of success of external cephalic version and attempt it as quickly as possible, if I thought it might work. If the patient was not an ideal candidate for vaginal birth, I would schedule a cesarean section for as soon as possible, or even do one right then and there at the first admission, to prevent just such a disaster. The extent to which this patient was dilated suggests either that she was in early labor or is likely to go into labor soon, which is what apparently happened. The patient should have received closer care than she was given in this case, and should not have been sent home in her condition.