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misdiagnosis during pregnancy

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LUCINDA574

Junior Member
What is the name of your state?Indiana

During my pregnancy my appendix burst and wasn't diagnosed properly for 9 days. I went to my OB complaining of extreme pain and uinability to keep anything down for 3 days who said nothing was wrong except my ligaments were stretching and it was morning sickness. I then was referred by same dr next night to go to ERs at the labor and delivery triage at the local hospital This Dr saaid I had a kidney infection and kept me in the hospital for 2 days for this and preterm labor. They sent me home, still complaining of severe pain.Then 4 days later I couldnt take it anymore, called ob who told me I was being melodramatic and fi I really thought it was bad go back to ER.This Dr said it was gallstone. They scheduled me for surgery and the surgeon ordered a cat scan because he said the pain was too bad to be a gallstone and they discovered I had ruptured my appendix and t was full "frank/gross" pus and they had to insert a drain into my stomach while I was awake with no pain medication while in the cat scan. It had burst 9 days before the surgeon assumes. I went into pre eclampsia at 34 weeks after the appendix ruptured and they had to do an emergency c-section. They had to cut me from bellybutton down because they were afraid they would hit infection and it would get to the baby. my daughter spent 2 weeks in NICU as she could not breath on her own but was a 7lb 13 oz baby. I feel it was all because of the appendix and all the vicodin and percocette they gave me during the pregnancy for 3 weeks. They also gave me morphine via a pump after they inserted the drain also. They finally removed the appendix 6 weeks after baby born. Do I have a case at all?thanks
 
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rmet4nzkx

Senior Member
Diagnosis and treatment of Abdomenal pain is complicated by the pregnancy. There are a number of conditions, some of which may or not require surgery. You didn't say when this happened or at what week this occured, but I'm assuming that it was near term based on the weight of your baby and the 3rd trimester is the most likely time for appendicitis during pregnancy which may also mask the diagnosis. Your unique presentation may have dictated exactly how you were treated before and after diagnosis.

From what you say you were refered to the ER/LD by your OB for further workup and eventually diagnosed with ruptured Appendix that had formed an abcess, that was the reason for the drain and why it was removed 6 weeks after birth. This means that the contents of the appendix/puss was confined to a small part of your abdomen and why they felt, based on the CT, that it was better to drain the abcess and do the emergengy C Section with the vertical incision.

While you have not related all the details that would be found in your chart, you have related the ones you felt indicated, "misdiagnosis" as opposed to delayed diagnosis complicated by a near term pregnancy. As traumatic an experience you may have had, it sounds as if it was within the standard of care. Yes, it is possible that the medications for pain or the infection may have affected your child's breathing, but is your child healthy now and at least 6 weeks of more in age? Have you recovered from the eventual removal of the appendix, were there any other complications? Have any of the doctors who have treated you suggested that you take legal action or that there was a serious deviation in the standard of care?

http://www.emedicine.com/med/topic3522.htm
 

ellencee

Senior Member
LUCINDA574 said:
What is the name of your state?Indiana

During my pregnancy my appendix burst and wasn't diagnosed properly for 9 days. I went to my OB complaining of extreme pain and uinability to keep anything down for 3 days who said nothing was wrong except my ligaments were stretching and it was morning sickness. I then was referred by same dr next night to go to ERs at the labor and delivery triage at the local hospital This Dr saaid I had a kidney infection and kept me in the hospital for 2 days for this and preterm labor. They sent me home, still complaining of severe pain.Then 4 days later I couldnt take it anymore, called ob who told me I was being melodramatic and fi I really thought it was bad go back to ER.This Dr said it was gallstone. They scheduled me for surgery and the surgeon ordered a cat scan because he said the pain was too bad to be a gallstone and they discovered I had ruptured my appendix and t was full "frank/gross" pus and they had to insert a drain into my stomach while I was awake with no pain medication while in the cat scan. It had burst 9 days before the surgeon assumes. I went into pre eclampsia at 34 weeks after the appendix ruptured and they had to do an emergency c-section. They had to cut me from bellybutton down because they were afraid they would hit infection and it would get to the baby. my daughter spent 2 weeks in NICU as she could not breath on her own but was a 7lb 13 oz baby. I feel it was all because of the appendix and all the vicodin and percocette they gave me during the pregnancy for 3 weeks. They also gave me morphine via a pump after they inserted the drain also. They finally removed the appendix 6 weeks after baby born. Do I have a case at all?thanks
I see no damages that would not have occurred anyway. The appendix burst; no one caused it to happen. Once the appendix burst, surgery was going to performed. Managing it as they did, delaying surgery and delivering a baby that lived and went home with a mother that lived, is all for which one could hope, expect, or ask. To seek to sue these people is most inappropriate. You should be ashamed.

EC
 

LUCINDA574

Junior Member
ellencee said:
I see no damages that would not have occurred anyway. The appendix burst; no one caused it to happen. Once the appendix burst, surgery was going to performed. Managing it as they did, delaying surgery and delivering a baby that lived and went home with a mother that lived, is all for which one could hope, expect, or ask. To seek to sue these people is most inappropriate. You should be ashamed.

EC

I should be ashamed?? Oh my............

Ok I was 19 weeks pregnant when this occured. I complained to my OB that I was having sharp pains and sever nausea- he advised for me to eat soda crackers and rest. Second day it was worse, called my OB again, he advised that I was a nervous first time mom and to go lay down. Third day I was so weak I could hardly walk, hadnt kept water or anything down, called OB- he was frustrated and told me to I could go to labor triage but he wouldnt see me right now and to keep my appt next month, said it was quote "my money I was wasting".They first Dr said I had a kidney infection and I was severely dehydrated and having pre term labor-hospitalized me for 2.5 days, antiboitics and terbutalene--sent me home on vicodin. I called the Dr the next day because the pain was unbearable--he told me kidney infections hurt and I would be ok.........prescribed me percocet and phenigran. Next Day I am on the phone again-SSDD.Next day I pass out twice-hubby calls OB--he says for me to rest and make an appt for next week. Next day I can no longer take it- Dr nurse advises me to go get bloodwork. I go to Dr after then,demanded to see the Dr- he told me I was being melodramatic- told me there was nothing he could do for me and I was "free to go to the ER' and they would tell me the same thing. Thats when that Dr said I had a gallstone and scheduled surgery and the surgeon is the one that ordered the CAT scan and basically saved me and my daughters life....they said I had gone "septic" and was in pre term labor again--2 cm dilated,30 effaced.They put a drain in me with no anesthesia nothing because the baby was having problems.I was stuck in a recliner for 3 weeks on vicodin and percocet and oral terbutalene with bags and bags of green goo coming out of me---IN PAIN- and I should be ashamed of myself???? I had 2 nurses and my surgeon say it was negligence. Funny part is my OB went on a leave of absence the next day and I never saw him untill my baby was born..........makes you wonder.The drain was taken out about a month after it was inserted but we constantly battled a systemic infection that did not go away until they were able to take the rest of the appendix out 6 weeks after my daughter was born. My daughter was born at 34weeks 5 days. SHe was on a vent, cpap and came home on a feeding tube and a monitor as she had apnea and irregular heartbeat. Yes she is healthy now, but it was a long 8 months to get her there. So dont ever ever tell me I should be ashamed. I lived in pain for over 2 months because they had misdiagnosed me. The only person that helped me was my surgeon, otherwise I and my daughter may be dead right now and he stated and so did the other surgeon who came in and talked to my mom and husband after they inserted the tube that if I hadnt gotten so full of infection they would have been able take it out before I would have gone septic or sepsis whatever the word was..........enough detail buddy? So according to you only if or baby die is it malpractice? Thats like saying drunk driving is ok until you hit and kill someone..........

and yes , I am ok now,I have a huge scar where they did the c-section from my belly button to my pubic pone, it dehissed 3 days after the baby delivered and it made the scar even worse. I think what gets me the most is all the hospital bills and the cost of the meds that I had to pay for that wouldnt have been needed had they caught it when the pain first started before it ruptured. My insurance was only 80/20 and I am still trying to pay off 10k in hospital bills. But to be totally honest, if the OB would have just once said he was sorry or admitted he was wrong I would not have been this upset. He treated me like poop- and almost cost me my life because he wouldnt listen to what I was saying.BTW I am 36 and this was my first baby and now I wont ever have another because I am not going thru a c section again.

I did talk to an attorney today and she wants to see my medical records.She advised that this is a case of negligence but no damage. I agree with her and at this point am just wanting him to be brought up for review which she said is reasonable. Thank you for input and have a good day.
 
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ellencee

Senior Member
Nothing out of the ordinary happened to you or to your baby. I doubt you have the emotional stability to read and comprehend medical information that is contrary to your need to be paid for having had a bad life experience, but if somewhere in the cobwebs of dollar signs and rage you have a brain, read some articles on the web.
http://www.emedicine.com/med/topic3522.htm
Physical examination
Upon physical examination, findings may be less prominent compared to those of nonpregnant patients with the same disorder (Cunningham, 1975; McGee, 1989) Peritoneal signs are often absent in pregnancy because of the lifting and stretching of the anterior abdominal wall. The underlying inflammation has no direct contact with the parietal peritoneum, which precludes any muscular response or guarding that would otherwise be expected (Sivanesaratnam, 2000). The uterus can also obstruct and inhibit the movement of the omentum to an area of inflammation, distorting the clinical picture.

To help distinguish extrauterine tenderness from uterine tenderness, performing the examination with the patient in the right or left decubitus position may prove helpful. When performing a physical examination of the gravid abdomen, it is essential to recall the changing positions of the intra-abdominal contents at different gestational ages. For example, the appendix is located at the McBurney point in patients in early pregnancy and in nonpregnant patients. After the first trimester, the appendix is progressively displaced upward and laterally, until it is closer to the gallbladder in late pregnancy (Baer, 1932). Such alterations in physical assessment can delay diagnosis, and many authorities attribute the increased morbidity and mortality of acute abdomen in gravid patients to this delay.
Laboratory evaluation When evaluating the gravid patient with acute abdominal pain, remember that some very commonly used laboratory tests have altered reference ranges in pregnancy. These changes can make the initial evaluation process somewhat more difficult. For example, an inflammatory process such as appendicitis would be expected to produce an elevated white blood cell count. Yet, pregnancy alone can produce white blood cell counts ranging from 6000-16,000/mm3 in the second and third trimesters and from 20,000-30,000/mm3 in early labor (Pritchard, 1962).
White blood cell count: In pregnancy, the white blood cell count is often as high as 15,000/mm3. The wide reference range limits the usefulness of white blood cell counts during pregnancy (Bailey, 1986). Severe disease can occur with a normal count. Polymorphonuclear leukocytes are often greater than 80% when appendicitis is present.

Urinalysis: Pyuria is observed in 10-20% of patients with appendicitis (Bailey, 1986). This may represent coincident asymptomatic bacteriuria.
Article after article describe findings and outcomes that occur because of appendicitis and/or ruptured appendicitis in pregnancy. You consider the events to represent gross negligence and most likely seek to become an instant multi-millionaire, or perhaps you don't want the money and just want to save others from suffering the same fate (yeah, right; you and every other poster like you).

Tell you what, go hire a medmal attorney and after the records are reviewed and the expert medical witnesses have opined and your claim is dismissed, come back and tell us about it. I, for one, will pencil your future post onto my calendar. Let's see, if you get an attorney in September '05, you should have a medical expert by, say, March '06, and the expert should opine by July '06, and your claim will be dismissed probably somewhere around Christmas '06. I'll be waiting.

EC
 

rmet4nzkx

Senior Member
Wow! Quite a different set of facts, whith different implications, however, as the attorney said a review of the records, both from the OB AND hospital is required. You are set on this being misdiagnosis by the OB whereas in fact, at 19 weeks when the baby was not viable and experiencing pre term labor brought on by dehydration, you were given a diagnosis from the L&D triage at the hospital and you were appropriately treated for kidney infection, severe dehydration, pre term labor, you were hospitalized for 2.5 days, placed on antiboitics and terbutalene and sent home on vicodin.

Please remember there is a difference between misdiagnosis and delayed diagnosis. If you read the link I provided, you saw the long list of possible causes of your symptoms, also since you were only 19 weeks, not further along and over 30 years of age, it was less likely appendix until the 3rd trimester, so the doctors were going to look at the most common reasons for your pain, it is also possible tha tyou had more than one problem or that one triggered a series of events. Since you were experiencing a high risk pregnancy, preterm labor at advanced age, with a first pregnancy, at a point when the fetus was not viable, the risk of surgery since you were already experiencing preterm labor was far greater at a point when even the least traumatic surgery could have triggered labor at a point when your child, who you now hold in your arms and tuck into bed each night was not viable. It is also possible that you did have a kidney infection and because you had both a large baby and were dehydrated, that the dehydration caused the appendicitus after release from the first hospitalization.

At no point do you tell us if your baby's lungs were evaluated or that they were ripened with steroids by the hospital when you were there in PTL. This may account for the breathing problems more so than the medications alone. By the size of your baby at birth, one would have assumed she was more than 34 weeks. Then you say, "Next day I pass out twice-hubby calls OB" You passed out twice, why didn't your husband take you to the ER, since they were the ones who had most recently treated and released you? You were again treated by the hospital when they diagnosed your ruptured/abcessed appendix at some point when the baby is not viable and you are at risk from PTL, since it was absessed it was successfully drained so that you didn't require surgery until well after your baby was born, and the drain was removed well before the baby was born so the acute infection, "septic" condition was controlled.

Please remember that sometimes terms like septic may be used or comments may be made to communicate which may be different than what is found in the chart and may seem to the layperson, to be inappropriate for the symptoms or diagnosis. The opinion for the nurse or the surgeon as to malractice by a doctor who appropriately referred you to the L&D and the hospital who treated you, seems to be finger pointing to avoid responsibility of the hospital more so than Your OB's fault.

Because of the baby's large size, you may have had other complications which you have not related and there may have been some confusion as to the dating of the pregnancy. At what week did you have amnio if you had it? Was there any concern for preeclampsea or diabetes? At what week were you given steroids to ripen the lungs prior to the C section?

The reason the attorney wants to see the medical records is to see if there is some malpractice that did occur even though your child is alive today because of the extraordinary efforts of the various medical professionals who treated both of you.

If you are only interested in making complaints and not fighting an expensive and stressfull lawsuit, you may make complaints to the medical board against all doctors involved and against the hospitals. You may because of the traumatic birth and breathing problems wish to have your child evaluated for learning and developmental disabilities, most states offer early intervention programs in cases such as yours.
 
I bet you would be screaming like hell if they had gone ahead with some procedures that could have been performed and you lost your baby. Seems they are in a no win situation with you.
 

bononos

Senior Member
OP - Count your blessings!
Approximately 30 years ago, my mother's best friend lost her daughter this way. It was because whatever the toxins the appendix releases almost killed her then after the c-section, 2 days later, the baby died. It was not diagnosed right away either.
 

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