Need advice - Ureteral Injury during C/S

Published Sep 4, 2006

204 Posts

I haven't posted in a long time, but need some advice/feedback from those of you who work in OB. I had my son (my first baby) 5 weeks ago after being induced with pitocin at term. I labored for 19 hrs total, had an epidural around 5 cm dilation. My regular doc was on vacation, so I had another OB from the practice during labor (I had never met her before). I dilated to 10cm and started pushing - about an hour later, the baby started having late decelerations with HR down to the lower 60's. In all, I pushed for 4 hours, the last hour and a half the baby made no progess - he remained in the same position in the birth canal, all the while having intermittent late decels that increased in frequency as time went on. We could see about 2 inches of the top of his head w/ each contraction. Toward the end, the OB tried the vaccuum 3 times without success, which made his HR drop even more. I told her about 5 times that I thought the baby was stuck, but she just told me to push harder. She let the epidural wear off the last hour thinking it would help me push more efficiently (I never felt the urge to push, but was pushing as hard as I possibly could). Finally after 4 hrs of pushing, she decided to do an emercency C/S due to fetal distress.

They removed the epidural and placed a spinal for the C/S. The baby's head was so far down that they couldn't push him back up through my abdomen. A nurse started pushing on his head from below, causing my body to move up and down on the table with the effort. When his head finally came up through the birth canal, my uterus and cervix tore down the left side all the way to the lady parts and I started hemmorhaging. The OB and 3rd year resident that was assisting were repairing the tear quickly, and the attending OB stitched my left ureter to my uterus inadvertantly. Then they closed the abdominal incision. The attending OB suspected something wasn't quite right, so they injected indigo carmine IV and realized there was no flow through the ureter. They called in urology, who tried to thread a catheter up through the ureter without success. I ended up going back to surgery an hour later with the urologist under general anesthesia to have the stitch removed and a ureteral stent placed. (The ureter is now healed and I've since had the stent removed).

I would like to know if any of the above constitutes malpractice - why did she let me push so long? She told me after that he was OP presentation, his neck was extended back and cocked to the left side. Shouldn't she have known this during the pushing stage and maybe tried to adjust his position?

By pushing for 4 hours and using the vaccuum, did she cause the lining of the uterus to become so compressed and thinned out that it tore more easily when his head came back up through? Did she put me at risk for an emergency hyst? Why did she close the incision if she thought she had damaged the ureter?

Thanks to all who take the time to read this. I am having a hard time making sense of what happened. Thankfully my son and I are both doing fine now, but it was quite a traumatic experience for the both of us. I would appreciate any advice or words of wisdom.

Thanks so much :wink2: