Pregnant woman collapsed with ruptured uterus
A pregnant woman writhing in pain collapsed with a ruptured uterus after 17 hours in hospital.
Her baby died about a month later. Waikato DHB’s care for ‘‘Mrs C’’ didn’t meet its obligations, Deputy Health and Disability Commissioner Rose Wall found in a report released yesterday.
However, a uterine rupture in this situation is ‘‘extremely rare’’. The woman, referred to as Mrs C, was 28 weeks pregnant when she arrived at a Waikato hospital with abdominal pain.
Medical staff considered causes such as a blocked bowel, but still didn’t know what was wrong when she collapsed 17 hours later. A rupture in her uterus was discovered when her baby was delivered by emergency caesarean section.
Baby C initially survived, but died a month later because of birth hypoxia – not getting enough oxygen.
‘‘This whole experience has left me completely emotionally and physically drained and distrustful of the medical profession,’’ Mrs C told the commission.
Waikato DHB has since upped obstetrics staffing, according to the report, with more registrars, midwives, and senior medical officers. It also held a teaching session on uterine rupture.
Mrs C told her midwife ‘‘I . . . thought I was dying’’ while returning from an ultrasound scan. She collapsed soon after, about 6.42pm, and her baby daughter was delivered by emergency caesarean section.
The rupture in her uterus was then discovered. Baby C spent 25 days in the neonatal intensive care unit (NICU), before her death.
Earlier on the day of Mrs C’s collapse, about 10am, she described excruciating pain.
‘‘All I could do was sob,’’ she said. A registrar described her writhing in pain, and later notes describe her gripping bedsheets. Mrs C was in her late 30s and had a history of severe endometriosis and surgery.
Taking more than 12 hours for a surgical review and scan ‘‘does not seem to reflect the urgency that the pain symptoms would suggest’’, said expert adviser and obstetrician Professor Peter Stone.
‘‘[Mrs C’s] symptoms were out of proportion to the signs and really quite large to almost excessive amounts of pain relief were given for an undiagnosed situation and yet there was no therapeutic plan.’’
The ‘‘rare and catastrophic’’ case was traumatic, said Dr A, an obstetrics consultant.
‘‘Nonetheless we were able to save [Mrs C] and, we thought, [Baby C]. Her death was very sad for all concerned.’’
It was so rare for a woman’s unscarred uterus to rupture when she was not in labour that a DHB like Waikato would only expect to see it once in 20-25 years, Dr A said.
Wall agreed that few clinicians would have considered or made the rare ruptured uterus diagnosis before Mrs C collapsed. Many aspects of her care were well managed, but the DHB breached the Code of Health and Disability Services Consumers’ Rights.
Lapses included not getting more senior staffers to look over the case, and a lack of effective communication between obstetrics and general surgery teams. Dr A, the obstetrics consultant, also received an adverse comment.
Mrs C had seven medical reviews, but none by obstetrics between 12.50pm and her collapse, the commission’s report said.
It took too long for Mrs C to get her ultrasound – an important diagnostic step.
And neither obstetrics nor general surgery ‘‘took full management responsibility or had the necessary sense of urgency’’.
Wall made a series of recommendations to Waikato DHB – all now implemented — including reporting on outcomes of its review, and showing proof of recent staff training, and apologising to Mrs C and her family.