OB/GYN MALPRACTICE

SCOTT M. LEWIS Member of the Bar of the State of Ohio

Wiley Law Publications

JOHN WILEY & SONS

New York · Chichester · Brisbane · Toronto · Singapore

SUMMARY CONTENTS

PART I LEGAL ASPECTS OF OBSTETRICAL AND GYNECOLOGICAL MALPRACTICE

Chapter 1 Liability of the Physician 3

Chapter 2 The Physician's Case, Defenses, and Countersuits 55

Chapter 3 The Trial of a Malpractice Case: Pleading and Practice 79

PART II MANAGEMENT IN THE ANTEPARTUM PERIOD

Chapter 4 Prenatal Care and Diagnosis 111

Chapter 5 Preeclampsia and Eclampsia 143

Chapter 6 Fetal Maturity: Prematurity and Postmaturity 155

Chapter 7 Amniocentesis 173

Chapter 8 Hemolytic Disease of the Newborn 187

Chapter 9 Drug Therapy in Pregnancy 201

Chapter 10 Abortion 213

PART III MANAGEMENT OF LABOR AND DELIVERY

Chapter 11 Normal Labor and Dysfunctional Labor 235

Chapter 12 Pelvic Dystocia and Cephalopelvic Disproportion 255

Chapter 13 Induction of Labor and Oxytocin Stimulation 269

Chapter 14 Fetal Distress 285

Chapter 15 Abnormalities of the Cord and Placenta 307

Chapter 16 Obstetric Anesthesia and Analgesia 325

Chapter 17 Presentation, Position, and Breech Delivery 341

Chapter 18 Shoulder Dystocia and Brachial Plexus Injury 359

Chapter 19 Cesarean Section 367

Chapter 20 Forceps Operations 383

Chapter 21 Maternal and Newborn Concerns in the Postpartum Period 399

PART IV MEDICO-LEGAL CONCERNS IN GYNECOLOGY

Chapter 22 Contraception 423

Chapter 23 Dilation and Curettage 449

Chapter 24 Hysterectomy 455

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XIV

Chapter 25 Chapter 26

Appendixes

SUMMARY CONTENTS

Gynecological Diseases Gynecological Cancer

Glossary of Obstetrical and Gynecological Terms

Table of Cases Index

469 479

503 567 573 587

PART I

Chapter 1

§ 1.1 § 1.2 § 1.3 § 1.4 § 1.5 § 1.6 § 1.7 § 1.8 § 1.9 § 1.10 § 1.11 § 1.12 § 1.13 § 1.14 § 1.15 § 1.16 § 1.17

§ 1.18 § 1.19

§ 1.20 § 1.21 § 1.22 § 1.23 § 1.24 § 1.25 § 1.26 § 1.27

§ 1.28 § 1.29 § 1.30 § 1.31

DETAILED CONTENTS

LEGAL ASPECTS OF OBSTETRICAL AND GYNECOLOGICAL MALPRACTICE

Liability of the Physician

Basis of Liability-Generally

Elements of the Malpractice Case: Checklist

Medical Records Liability for Unauthorized Release of Records

The Organization of Obstetrical Records

Analyzing the Medical Record

Medical Guidelines for Records Altered Records: "Badges of Suspicion"

Medical Authorities Expert Evaluation of Case

Professional Negligence-Generally

Physician-Patient Relationship Establishment of Standard of Care Causation and Damages

Hospital Liability-Generally

-Liability for Negligence of Hospital Employees

-Liability for Negligent Acts of Physicians, Surgeons, Interns, and Residents -Liability for Failure to Supervise and Review Patient Care

- The Standard of Care Applicable to Hospitals.

Res Ipsa Loquitur-Generally

-Inference of Negligence

-Defendant's Exclusive Control of Instrumentality

- Applications in Obstetrical Cases

Breach of Express Warranty

Informed Consent

Exceptions to Requirement of Infonned Consent

Wrongful Life, Wrongful Birth, and Wrongful Pregnancy-Generally -Wrongful Birth

- The Benefit Rule

-Wrongful Life

- Wrongful Pregnancy

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XVI DET AILED CONTENTS

§ 1.32 Products Liability in Drug Cases-Generally

§ 1.33 Unavoidably Unsafe Products and the Duty to Warn

§ 1.34 Physician's Duty to Warn of Risks of Oral Contraceptives

Chapter 2 The Physician's Case, Defenses, and Countersuits

§ 2.1 A vailable Defenses-Generally

§ 2.2 Standard of Care § 2.3 The Defense of Contributory Negligence-Generally

§ 2.4 -Failure to Reveal Medical History

§ 2.5 -Failure to Return to Physician

§ 2.6 -Failure to Follow Instructions

§ 2.7 Comparative Negligence "

§ 2.8 Assumption of Risk

§ 2.9 Res Judicata and Collateral Estoppel

§ 2.10 Statutes of Limitations- Generally

§ 2.11 - The Cause of Action

§ 2.12 - Time of Accrual of the Cause of Action

§ 2.13 Countersuits for Malicious Prosecution

§ 2.14 Other Theories of Countersuit

Chapter 3 The Trial of a Malpractice Case: Pleading and Practice

§ 3.1 Introduction

§ 3.2 Plaintiff's Complaint

§ 3.3 Parties-Defendant

§ 3.4 Defendant's Answer

§ 3.5 Deposition of the Plaintiff

§ 3.6 Deposition of the Physician

§ 3.7 Other Discovery

§ 3.8 Motion Practice

§ 3.9 Jury Selection-Generally

§ 3.10 -Plaintiff's Jury Selection

§ 3.11 -Jury Selection for the Defendant-Physician

§ 3.12 Plaintiff's Opening Statement

§ 3.13 Defendant's Opening Statement

§ 3.14 Introducing Medical Records

§ 3.15 Medical Records and the Physician-Patient Privilege

§ 3.16 Establishing the Standard of Care

§ 3.17 Qualification of the Expert-Generally

§ 3.18 -Nonobstetrician as Expert

§ 3.19 Subject Matter of Expert Testimony

§ 3.20 Bases of Expert's Opinion

§ 3.21 The Hypothetical Question

§ 3.22 Use of Treatises to Establish Standard of Care

§ 3.23 Jury Instructions

PART II

Chapter 4

DETAILED CONTENTS

MANAGEMENT IN THE ANTEPARTUM PERIOD

Prenatal Care and Diagnosis

MEDICAL ASPECTS

§ 4.1 Introduction

§ 4.2

§ 4.3

§ 4.4

§ 4.5

Initial Patient Visit

Physical Examination

Subsequent Visits The Diagnosis of Normal Pregnancy

LEGAL LIABILITY

§ 4.6 Errors in Diagnosis of Normal Pregnancy-Generally

§ 4.7 - Diagnosis as Tumor

§ 4.8 - Diagnosis as Gallbladder Condition

§ 4.9 -Other Misdiagnoses

§ 4.10 -Exploratory Surgery § 4.11 Failure to Diagnose Pregnancy: Wrongful Pregnancy

MEDICAL ASPECTS: ECTOPIC PREGNANCY

§ 4.12 Ectopic Pregnancy: "The Great Masquerader"

§ 4.13 Diagnosis of Ectopic Pregnancy

§ 4.14 Treatment of Ectopic Pregnancy

LEGAL LIABILITY: ECTOPIC PREGNANCY § 4.15 Failure to Diagnose Ectopic Pregnancy

§ 4.16 Diagnosis of Ectopic Pregnancy as Constipation

§ 4.17 Diagnosis of Ectopic Pregnancy as Salpingitis

MEDICAL ASPECTS: RUBELLA § 4.18 Rubella § 4.19 Effects of the Virus

§ 4.20 Immunization

LEGAL LIABILITY: RUBELLA

§ 4.20 Failure to Diagnose Rubella: Wrongful Birth and Wrongful Life

Chapter 5 Preeclampsia and Eclampsia

MEDICAL ASPECTS

§ 5.1 Preeclampsia and Eclampsia-Generally

§ 5.2 Significance of Preeclampsia and Eclampsia

§ 5.3 Diagnosis of Preeclampsia and Eclampsia § 5.4 Prevention of Preeclampsia and Eclampsia § 5.5 Treatment of Preeclampsia and Eclampsia

LEGAL LIABILITY

§ 5.6 Failure to Diagnose Preeclampsia and Eclampsia

§ 5.7 Misdiagnosis of Eclampsia as Gallbladder Condition § 5.8 Failure to Obtain Patient's Records

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§ 5.9 § 5.10 § 5.11

DETAILED CONTENTS

Failure to Treat Preeclampsia

Administration of Spinal Anesthesia to Eclamptic Patient Delayed Treatment of Eclampsia

Chapter 6 Fetal Maturity: Prematurity and Postmaturity

MEDICAL ASPECTS: PREMATURITY § 6.1 Assessment of Maturity § 6.2 Prematurity § 6.3 Iatrogenic Prematurity § 6.4 Premature Labor

§ 6.5 Arr~st of Premature Labor § 6.6 Premature Rupture of the Membranes-Generally § 6.7 Management of Premature Rupture of the Membranes

§ 6.8 Incompetent Cervix § 6.9 Intrauterine Growth Retardation

LEGAL LIABILITY : PREMATURITY § 6.10 Negligent Amniotomy § 6.11 Premature Cesarean Section § 6.12 Intrauterine Growth Retardation as Defense

MEDICAL ASPECTS: POSTMATURITY § 6.13 Postmaturity § 6.14 Evaluation of Postmaturity § 6.15 Management of Postmaturity

LEGAL LIABILITY: POSTMATURITY § 6.16 Failure to Assess Postmaturity

§ 6.17 Misdiagnosis of False Labor § 6.18 Delayed Delivery § 6.19 Failure to Perform Cesarean Section

Chapter 7 Amniocentesis

MEDICAL ASPECTS

§ 7.1 Amniocentesis-Generally § 7.2 Indications for Amniocentesis § 7.3 Standards for Performance § 7.4 Prenatal Detection of Genetic Disorders

§ 7.5 Genetic Counseling § 7.6 Fetal Maturity Assessment § 7.7 Amniocentesis Technique

§ 7.8 Complications of Amniocentesis-Generally § 7.9 -Maternal Complications § 7.10 -Fetal Complications

DETAILED CONTENTS

LEGAL LIABILITY § 7.11 Failure to Advise of Amniocentesis: Wrongful Birth § 7.12 Failure to Advise of Amniocentesis: Wrongful Life

§ 7.13 Negligent Performance of Amniocentesis

Chapter 8 Hemolytic Disease of the NewBorn

MEDICAL ASPECTS § 8.1 Rh Hemolytic Disease-Generally § 8.2 Pathogenesis of Hemolytic Disease § 8.3 Identification of Rh-sensitized Mother § 8.4 § 8.5 § 8.6 § 8.7 § 8.8 § 8.9

Prevention of Hemolytic Disease

Diagnosis of Hemolytic Disease

Treatment of Hemolytic Disease ABO Hemolytic Disease

Hyperbilirubinemia

Treatment of Hyperbilirubinemia

LEGAL LIABILITY § 8.10 Negligent Administration of Incompatible Blood § 8.11 Failure to Administer RhoGAM

§ 8.12 Reliance on Erroneous Test Results

§ 8.13 Blood Exchange Transfusion

Chapter 9 Drug Therapy in Pregnancy

MEDICAL ASPECTS

§ 9.1 Historical Perspective § 9.2 Prenatal Drug Therapy Dilemma

§ 9.3 Immunosuppressants

§ 9.4 Antimicrobial Agents (Antibiotics)

§ 9.5 Hormones and Antihormones § 9.6 Socially Used Drugs § -9.7 Anticonvulsants

§ 9.8 Anticoagulants § 9.9 Miscellaneous Drugs

§ 9.10 Prevention of Teratogenesis

LEGAL LIABILITY

§ 9.11 Liability of the Physician

§ 9.12 Drug Product Liability Actions and the Duty to Warn § 9.13 Unavoidably Unsafe Products and the Duty to Warn

Chapter 10 Abortion

MEDICAL ASPECTS § 10.1 Definitions

§ 10.2 Viability and Roe v. Wade

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xx DETAILED CONTENTS

§ 10.3 Spontaneous Abortion-Generally § 10.4 Missed Abortion § 10.5 Threatened Abortion § 10.6 Incomplete and Inevitable Abortions § 10.7 Habitual Abortion § 10.8 Therapeutic or Elective Abortion-Generally § 10.9 Medical Guidelines for Elective or Therapeutic Abortion § 10.10 Indications for Therapeutic Abortion § 10.11 Dilation and Curettage § 10.12 Risks of Dilation and Curettage § 10.13 Hysterectomy and Hysterotomy § 10.14 Intra~amniotic Solutions to Effect Abortion § 10.15 Failure to Terminate Pregnancy § 10.16 Septic Abortion § 10.17 Summary of Complications of Abortion § 10.18 Abortion Follow-Up

LEGAL LIABILITY

§ 10.19 Legal Issues-Generally § 10.20 Wrongful Pregnancy § 10.21 Negligent Perforation of Uterus § 10.22 Duty to Continue Care of Patient

PART III

Chapter 11

MANAGEMENT OF LABOR AND DELIVERY

Normal Labor and Dysfunctional Labor

MEDICAL ASPECTS

§ 11.1 Stages of Labor

§ 11.2 Changes before Labor § 11.3 Cervical Effacement and Dilatation § 11.4 False Labor

§ 11.5 Stations of the Fetal Head § 11.6 Engagement

§ 11.7 Detection of Ruptured Membranes § 11.8 Dysfunctional Labor-Generally § 11.9 Complications of Uterine Dysfunction

§ 11.10 Uterine Dysfunction and the Friedman Curve

§ 11.11 Identifying Disorders of Labor § 11.12 Categories of Dysfunctional Labor § 11.13 -Prolonged Latent Phase § 11.14 - Treatment of Prolonged Latent Phase Disorder § 11.15 -Protracted Active Phase Dilatation § 11.16 - Treatment of Protracted Dilatation Disorder

§ 11.17 § 11.18 § 11.19 § 11.20

DETAILED CONTENTS

- Protracted Descent Phase Disorder - Arrest Disorders Duration of Second Stage of Labor

Precipitate Labor

LEGAL LIABILITY

§ 11.21 Mismanagement of Abnormal Labor-Generally § 11.22 Cephalopelvic Disproportion and Prolonged Labor § 11.23 Mismanagement of Precipitate Labor § 11.24 Misdiagnosis of False Labor

Chapter 12 Pelvic Dystocia and Cephalopelvic Disproportion

MEDICAL ASPECTS § 12.1 Dystocia of Pelvic Origin § 12.2 Pelvic Measurements § 12.3 Dystocia Due to Fetal Factors § 12.4 Cephalopelvic Disproportion § 12.5 Detection of Cephalopelvic Disproportion-Generally § 12.6 X-ray Pelvimetry § 12.7 Management of Cephalopelvic Disproportion

LEGAL LIABILITY

§ 12.8 Mismanagement of Cephalopelvic Disproportion

Chapter 13 Induction of Labor and Oxytocin Stimulation

MEDICAL ASPECTS § 13.1 Induction of Labor-Generally § 13.2

§ 13.3 § 13.4 § 13.5 .§ 13.6

§ 13.7 § 13.8

Amniotomy

Risks of Amniotomy Oxytocin Stimulation Guidelines for Oxytocin Administration Risks of Oxytocin Discontinuation of Oxytocin Contraindications of Oxytocin

LEGAL LIABILITY

§ 13.9 Introduction § 13.10 Administration of Oxytocin in Breech Presentation § 13.11 Administration of Oxytocin in Cephalopelvic Disproportion § 13.12 Contraindicated Administration of Oxytocin § 13.13 Failure to Monitor Effects of Oxytocin

§ 13.14 Premature Amniotomy

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XXll DETAILED CONTENTS

Chapter 14 Fetal Distress

MEDICAL ASPECTS

§ 14.1 Definition and Clinical Signs

§ 14.2 Electronic Fetal Heart Monitoring-Generally

§ 14.3 Indications for Use of Electronic Monitoring § 14.4 Fetal Heart Rate

§ 14.5 Baseline Fetal Heart Rate

§ 14.6 Variability of Fetal Heart Rate § 14.7 Periodic Fetal Heart Rate Changes

§ 14.8 - Pattern of Early Deceleration

§ 14.9 -Pattern of Late Deceleration

§ 14.10 -P~ttern of Variable Deceleration

§ 14.11 Monitoring Instrumentation-Generally

§ 14.12 -External Fetal Heart Monitoring

§ 14.13 -Internal Fetal Heart Monitoring § 14.14 Fetal Blood Sampling

§ 14.15 Indications for Fetal Blood Sampling § 14.16 Meconium

§ 14.17 Herpes Virus Infection during Pregnancy

§ 14.18 Treatment of Fetal Distress

LEGAL LIABILITY

§ 14.19 Failure to Use Electronic Fetal Heart Monitor

§ 14.20 Failure to Respond to Fetal Distress

Chapter 15 Abnormalities of the Cord and Placenta

MEDICAL ASPECTS § 15.1 Umbilical Cord Prolapse

§ 15.2 Diagnosis of Cord Prolapse

§ 15.3 Management of Cord Prolapse

§ 15.4 Iatrogenic Prolapse

§ 15.5 Loops of the Cord § 15.6 Placenta Previa § 15.7 Signs and Symptoms of Placenta Previa

§ 15.8 Diagnosis of Placenta Previa

§ 15.9 Ultrasonic Localization

§ 15.10 Management of Placenta Previa § 15.11 Abruptio Placenta

§ 15.12 Diagnosis of Abruptio Placenta

§ 15.13 Treatment of Abruptio Placenta

LEGAL LIABILITY

§ 15.14 Negligent Management of Cord Prolapse § 15.15 Negligent Management of Abruptio Placenta

DETAILED CONTENTS

§ 15.16 § 15.17

Negligent Management of Placenta Previa

Negligent Management of Placenta Accreta

Chapter 16 Obstetrical Anesthesia and Analgesia

MEDICAL ASPECTS § 16.1 Significance of Anesthesia-Generally

§ 16.2 Medical Guidelines for Anesthesia § 16.3 Special Considerations in Obstetrical Anesthesia § 16.4 Analgesia and Sedation during Labor § 16.5 Paracervical Block § 16.6 Pudendal Block § 16.7 Spinal Anesthesia § 16.8 Complications with Spinal Anesthesia § 16.9 Contraindications to Spinal Anesthesia

§ 16.10 Epidural Block § 16.11 Complications of Epidural Block § 16.12 General Anesthesia for Cesarean Section § 16.13 Aspiration of Vomitus in General Anesthesia

§ 16.14 Treatment of Aspiration § 16.15 Prevention of Death in Obstetric Anesthesia

LEGAL LIABILITY § 16.16 Aspiration of Vomitus

§ 16.17 Failure to Obtain Informed Consent to Spinal Anesthesia § 16.18 Administration of Saddle Block § 16.19 Saddle Block Administered to Eclamptic Patient § 16.20 Negligent Endotracheal Intubation § 16.21 Administration of Paracervical Block § 16.22 Administration of Epidural Anesthesia § 16.23 Administration of Valium

Chap,ter 17 Presentation, Position, and Breech Delivery

MEDICAL ASPECTS § 17.1 Presentation and Position-Generally § 17.2 Cephalic Presentation § 17.3 Vertex Presentation and Positions § 17.4 Vertex Delivery § 17.5 Normal Spontaneous Vaginal Delivery § 17.6 Episiotomy § 17.7 Delivery of the Shoulders § 17.8 Face Presentation

§ 17.9 Brow Presentation § 17.10 Transverse Presentation § 17.11 Route of Delivery

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§ 17.12 § 17.13 § 17.14 § 17.15 § 17.16 § 17.17

DETAILED CONTENTS

Breech Presentation-Generally

- Incidence and Diagnosis

-Significance of Breech Presentation -Management of Vaginal Breech Delivery

- Methods of Vaginal Delivery

-Trends in Management of Breech Presentation

LEGAL LIABILITY

§ 17.18 Failure to Perform X-ray Pelvimetry

§ 17.19 § 17.20

§ 17.21

Chapter 18

Hyperextension of Head Excessive Force in Vaginal Delivery Injury to Mother in Footling Breech

Shoulder Dystocia and Brachial Plexus Injury

MEDICAL ASPECTS

§ 18.1 Significance of Shoulder Dystocia § 18.2 Treatment of Shoulder Dystocia

§ 18.3 Brachial Plexus Injuries

LEGAL LIABILITY

§ 18.4 Occipital Fracture and Brachial Plexus Injury

§ 18.5 Diabetic Mother and Shoulder. Dystocia

Chapter 19 Cesarean Section

MEDICAL ASPECTS

§ 19.1 Definition and Types

§ 19.2 Indications and Contraindications-Generally

§ 19.3 Specific Indications for Cesarean Section § 19.4 Repeat Cesarean vs. Vaginal Delivery

§ 19.5 Complications of Cesarean Section

§ 19.6 Incidence of Cesarean Section

§ 19.7 Medical Guidelines for Cesarean Section

LEGAL LIABILITY § 19.8 Legal Aspects of Cesarean Delivery-Generally § 19.9 Failure to Perform Cesarean Section

§ 19.10 Delayed Performance of Cesarean Section

§ 19.11 Premature Performance of Cesarean Section

§ 19.12 Negligent Performance of Cesarean Section

Chapter 20 Forceps Operations

MEDICAL ASPECTS § 20.1 Forceps Operations-Generally

§ 20.2

§ 20.3 § 20.4

Definitions and Classifications

Indications for Forceps Delivery Prerequisites for Use of Forceps

§ 20.5 § 20.6 § 20.7

§ 20.8

DETAILED CONTENTS

Application of Forceps Low Forceps Operations Midforceps Operations

Vacuum Extraction

LEGAL LIABILITY § 20.9 Use of Forceps in Cephalopelvic Disproportion § 20.10 Misdiagnosis of Position § 20.11 Forceps in Transverse Lie

§ 20.12 Forceps in Shoulder Dystocia § 20.13 Misapplication of Forceps § 20.14 Failure to Use Forceps

Chapter 21 Maternal and Newborn Concerns in the Postpartum Period

MEDICAL ASPECTS: POSTPARTUM MANAGEMENT § 21.1 Maternal Complications in the Postpartum Period-Generally

§ 21.2 Medical Guidelines § 21.3 Postpartum Hemorrhage § 21.4 Causes and Prevention of Postpartum Hemorrhage § 21.5 Management of Postpartum Hemorrhage § 21.6 Postpartum Shock

§ 21.7 Management of Shock § 21.8 Placenta Accreta § 21.9 Infections

LEGAL LIABILITY: POSTPARTUM MANAGEMENT § 21.10 Mismanagement of Postpartum Hemorrhage

§ 21.11 Abcess from Uterine Packing

MEDICAL ASPECTS: CARE OF THE NEWBORN. § 21.12 Immediate Care of the Newborn § 21.13

§ 21.14 § 21.15

§ 21.16 § 21.17 § 21.18

Evaluation of the Newborn

Suctioning and Meconium Aspiration Resuscitation of the Newborn-Generally

Resuscitative Standards and Procedures Ventilation and Cardiac Massage Retrolental Fibroplasia

LEGAL LIABILITY: CARE OF THE NEWBORN

§ 21.19 Inadequate Resuscitation § '21.20 Liability for Retrolental Fibroplasia

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PART IV

Chapter 22

DETAILED CONTENTS

MEDICO-LEGAL CONCERNS IN GYNECOLOGY

Contraception

INTRODUCTION

§ 22.1 Introduction

MEDICAL ASPECTS: ORAL CONTRACEPTIVES § 22.2 Oral Contraceptives: Benefits and Risks § 22.3 § 22.4 § 22.5 § 22.6 § 22.7 § 22.8

Cardiovascular Effects

Neoplasia

Hypertension

Other Effects of Oral Contraceptives Contraindications to Use of Oral Contraceptives

Monitoring of Patients

LEGAL LIABILITY: ORAL CONTRACEPTIVES

§ 22.9 Failure to Obtain Informed Consent

§ 22.10 Administration to Patient with Migraine Disorder § 22.11 Failure to Diagnose Patient with Thrombophlebitis

MEDICAL ASPECTS: IUD § 22.12 Intrauterine Devices: Types § 22.13 Adverse Effects

§ 22.14 Contraindications to IUD Use § 22.15 Insertion and Replacement

LEGAL LIABILITY: IUD

§ 22.16 Breach of Duty to Wa~ § 22.17 § 22.18 § 22.19

Failure to Locate and Remove IUD

Improper Insertion of IUD Legal Liability of the Dalkon Shield

MEDICAL ASPECTS: STERILIZATION

§ 22.20 Sterilization

§ 22.21 Indications for Sterilization

§ 22.22 Contraindications and Hazards

LEGAL LIABILITY: STERILIZATION

§ 22.23 Failure to Obtain Informed Consent

§ 22.24 Injury to Patient

§ 22.25 Wrongful Pregnancy

Chapter 23 Dilation and Curettage

MEDICAL ASPECTS § 23.1 Technique of Dilation and Curettage

§ 23.2 . Indications and Complications

DETAILED CONTENTS XXVll

LEGAL LIABILITY § 23.3 Failure to Perform Dilation and Curettage § 23.4 Premature Release from Hospital § 23.5 Perforation of Uterus

§ 23.6 Incomplete Dilation and Curettage

Chapter 24 Hysterectomy

MEDICAL ASPECTS § 24.1 Incidence of Hysterectomy § 24.2 Medical Indications for Hysterectomy

§ 24.3 Types of Hysterectomy

§ 24.4 Complications of Hysterectomy

LEGAL LIABILITY § 24.5 Bases of Liability-Generally

§ 24.6 Failure to Obtain Informed Consent

§ 24.7 Negligence-Generally

§ 24.8 Unnecessary Hysterectomy

§ 24.9 Removal of Healthy Organs § 24.10 Postoperative Care

Chapter 25 Gynecological Diseases

MEDICAL ASPECTS

§ 25.1 Pelvic Infections-Generally

§ 25.2 Gonorrhea § 25.3 Syphilis § 25.4 Herpes

§ 25.5 Salpingitis

§ 25.6 Endometriosis

LEGAL LIABILITY

§ 25.7 Improper Diagnosis and Treatment of Endometriosis § 25.8 Misdiagnosis of Syphilis

§ 25.9 Misdiagnosis of Gonorrhea § 25.10 Misdiagnosis of Pelvic Inflammatory Disease

Chapter 26 Gynecological C~ncer

MEDICAL ASPECTS: BREAST CANCER § 26.1 Breast Cancer-Generally

§ 26.2 Forms of Breast Cancer

§ 26.3 Signs and Symptoms of Breast Cancer § 26.4 Diagnosis of Breast Cancer § 26.5 Differential Diagnosis § 26.6 Treatment of Carcinoma of the Breast § 26.7 Women at High Risk for Breast Cancer

xxviii DETAILED CONTENTS

LEGAL LIABILITY: BREAST CANCER § 26.8 Failure to Diagnose Breast Cancer § 26.9 Failure to Obtain Informed Consent

MEDICAL ASPECTS: CERVICAL CANCER § 26.10 Carcinoma of the Cervix: Types and Definitions § 26.11 § 26.12

Diagnosis of Cervical Cancer

Treatment of Cervical Cancer

LEGAL LIABILITY: CERVICAL CANCER § 26.13 Failure to Diagnose Cervical Cancer § 26.14 Failure to Obtain Informed Consent

MEDICAL ASPECTS: OVARIAN CANCER

§ 26.15 <;lvarian Neoplasms § 26.16 Signs and Symptoms of Ovarian Cancer § 26.17 Diagnosis and Management of Ovarian Cancer

LEGAL LIABILITY: OVARIAN CANCER § 26.18 Liability Arising from Treatment of Ovarian Cancer

Appendixes

A. Sample Medical Records B. Authorization for Release of Medical Records

C. Expert Medical Evaluation for Plaintiff D. Expert Medical Evaluation for Defendant E. Physician's Letter to Patient Who Fails to Keep Appointment F. Physician's Letter to Patient Who Fails to Follow Advice G. Complaint H. Answer of Physician

I. Answer of Hospital J. Direct Examination of Plaintiff's Expert K. Consent Form L. Abbreviations in Medical and Hospital Records M. Hospital Obstetrical Rules and Regulations N. Physician Notes O. Interrogatories of Defendant-Physician

Glossary of Obstetrical and Gynecological Terms

Table of Cases

Index