r42187_107886Last week the Internet was replete with stories regarding two North Carolina obstetricians who performed a c. section on a non-pregnant woman (see ABC News).  Sadly, mistakes of this magnitude occur more often than the public is made aware to the detriment of both unsuspecting patients and unsupervised resident physicians.

Residency training is a pecking order and the neophyte intern is the first responder. He or she must evaluate the patient, and then report their findings to their senior resident or attending physician. More than likely this particular patient was obese and had “no previous prenatal care.” According to the ABC News report, the intern performed an ultrasound and was not able to “see a fetal heart tone.” It’s possible that the intern thought the patient’s baby had died and ordered an induction of labor for its delivery.  The “induction” allegedly lasted two days and the patient and her husband requested a c. section.  The case was allegedly discussed with a senior resident and attending physician who agreed with the intern’s management. Upon entry of the uterine cavity, a non-pregnant uterus was diagnosed to the chagrin of the physicians and the patient’s abdomen was quickly closed.  Here come the lawyers.

Let’s rewind the tape, then hit the play button and describe what SHOULD have happened:

  1. The intern takes the patient’s history and then examines the patient to determine whether the patient’s cervix is dilated (open) and if the baby’s head is down. If she can’t feel the head, she needs to order an ultrasound in the radiology department. If it’s after hours and a radiologist is unavailable, she can do an “unofficial” scan and see if the scan can be read by either an offsite radiologist via telemedicine or her attending physician.
  2. She attempts to obtain a fetal heart. If none is obtained, she needs an OFFICIAL ultrasound to make certain the baby is alive.

Doing steps 1 and 2 would have documented an empty, non pregnant uterus and eliminated unnecessary surgery. Also, the intern’s senior physician and attending should have BOTH examined the patient to confirm or dispute the intern’s exam.  

Our ob-gyn protocols are clearly established. Why on earth can’t we follow them?