Causes of Severe Coma and Organ Failure in Postpartum Women

Q: Causes of Severe Coma and Organ Failure in Postpartum Women

Hello Mr. <br>Chen Yinchuan： Regarding the questions you raised, postpartum hemorrhage is a complex issue, and I cannot provide answers to points 2, 3, 4, and 5. <br>However, advanced maternal age is not an absolute indication for cesarean delivery, and this point should be clear

Causes of severe coma or brain death, as well as multiple organ failure in parturients?

Dear Dr.
Hsu,
My sister-in-law was seen for prenatal check-ups on June 20, June 27, and July 4, 2003, and was admitted for delivery on July 4, 2003.
On July 5, 2003, at 1:23 PM, she delivered a mature male infant vaginally at full term.
The hospital informed us that the mother experienced significant hemorrhaging.
Around 3 PM, the hospital notified us that she had poor uterine contractions and urged us to quickly obtain blood from the blood bank for an emergency transfusion and a hysterectomy.
By around 6 PM, she was taken out of the operating room and transferred to the surgical intensive care unit.
When we saw her, she was in a deep coma and unresponsive.
While we were waiting in the rest area, we noticed the nursing staff frequently taking blood from the ICU, which heightened our sense of urgency and distress.
On July 6, she underwent exploratory laparotomy to remove blood and had a urinary catheter placed.
On July 7, she was transferred to the medical intensive care unit for treatment, but her transfusion situation did not improve, and her heart rate remained around 139.
The ICU doctors repeatedly informed us that her pupils were dilated and asked whether we wanted to sign a natural death declaration or opt for resuscitation (the declaration had not yet been signed).
On July 9, another physician performed surgery, and her heart rate improved to 110, along with significant improvements in transfusion needs; however, all her organs remained non-functional, her liver enzymes were extremely high, she required daily dialysis, had a bacterial infection, and was unable to breathe without a ventilator.
To this day, she remains completely unresponsive and has become a vegetative state.
I have several questions I would like to ask Dr.
Hsu:
1.
Given the advancements in medical technology, is a 39-year-old woman having her second child (her first daughter is already 17 years old) considered a high-risk pregnancy? I had requested a cesarean delivery, but the hospital, in consultation with cardiology and pulmonology, assessed her for vaginal delivery (as the mother had experienced some respiratory issues due to overload after 30 weeks).
2.
Did the hospital exhibit gross negligence (not involving cardiology and pulmonology during delivery)?
3.
Is there evidence of gross negligence if she went into shock and did not receive resuscitation within a few minutes (the golden hour), potentially leading to hypoxic brain injury and multiple organ failure?
4.
After signing the natural death declaration, would it hold up in the event of a future medical dispute?
5.
Is it possible to file a lawsuit against the hospital for negligence resulting in the mother becoming a vegetative state?
Sincerely,
Chen Yin-Chuan

Yin, 40~49 year old female. Ask Date: 2003/07/22

Dr. Xu Junzheng reply Obstetrics and Gynecology

Hello Mr.
Chen Yinchuan: Regarding the questions you raised, postpartum hemorrhage is a complex issue, and I cannot provide answers to points 2, 3, 4, and 5.
However, advanced maternal age is not an absolute indication for cesarean delivery, and this point should be clear.
Thank you.

Reply Date: 2003/07/22

More Info

The case you presented raises significant concerns regarding postpartum complications, particularly severe coma and organ failure in women after childbirth. This situation is indeed tragic and highlights the complexities involved in maternal health care, especially for women classified as high-risk due to age or pre-existing conditions.

1. High-Risk Pregnancy: At 39 years old, a woman is generally considered a high-risk pregnancy, particularly if it is her second child after a significant gap (17 years in this case). Advanced maternal age can increase the risk of complications such as gestational diabetes, hypertension, and issues related to labor and delivery. The medical team should have closely monitored her throughout the pregnancy, especially given her history and the noted respiratory issues in the later stages.

2. Medical Oversight: The question of whether there was a serious medical oversight is crucial. If the medical team was aware of the potential complications due to the patient’s age and health status, it would be expected that they would involve specialists such as cardiologists and pulmonologists in the delivery plan. The absence of these specialists during a high-risk delivery could be seen as a lapse in standard care protocols, which may contribute to claims of negligence.

3. Timing of Intervention: The concept of "golden hour" in emergency medicine emphasizes the critical nature of timely intervention. If the patient experienced severe hemorrhaging and uterine atony (failure of the uterus to contract), immediate action is essential to prevent hypovolemic shock, which can lead to organ failure and brain damage due to lack of oxygen. If there was a delay in addressing these issues, it could be a significant factor in the patient's current condition.

4. Legal Considerations: Signing a natural death consent form can complicate future legal actions. If the family signed this document, it may indicate acceptance of the patient's condition as irreversible, potentially limiting claims of medical malpractice. However, if it can be demonstrated that the medical team failed to provide the standard of care expected in such situations, there may still be grounds for a lawsuit.

5. Pursuing Legal Action: If there is substantial evidence suggesting that the medical team did not act in accordance with established medical standards, it may be possible to pursue legal action for malpractice. This would typically require the testimony of medical experts who can evaluate the care provided and determine if it fell below the acceptable standard.

6. Determining Brain Death: The determination of brain death or a persistent vegetative state typically involves a thorough evaluation by a neurologist or a critical care specialist. This includes neurological examinations, imaging studies, and sometimes additional tests to confirm the absence of brain activity.

In conclusion, the situation described is complex and multifaceted, involving medical, ethical, and legal dimensions. It is crucial for the family to seek the counsel of a legal professional who specializes in medical malpractice to explore their options. Additionally, ongoing communication with healthcare providers is essential to ensure that the patient receives the best possible care and that any concerns are addressed promptly. The emotional and psychological impact on the family cannot be understated, and they may benefit from support services as they navigate this challenging time.

Similar Q&A

Understanding Coma: Causes, Treatments, and Recovery in Elderly Patients

My mother is 86 years old. After a nap on January 8, she could not be awakened. That evening, her blood sugar was measured at 183, her blood oxygen level was 89, and her blood pressure was normal. On January 19, she still could not be awakened in the morning, and her blood sugar ...

Dr. Jiang Junyi reply Neurology
Dear Ms. Vicky, You mentioned, "Doctors only treat infections with antibiotics. I really want to ask, for a comatose patient like this, do we just have to wait aside from antibiotic treatment? Are there no more aggressive treatment options?" In clinical practice, the m...

Understanding Severe Edema in Pregnant Women: Causes and Concerns

Hello Dr. Chen: My sister-in-law is 37 years old and during her seventh month of pregnancy, she suddenly developed full-body edema after taking cold medication, which has persisted for over a month. Her neck is also swollen, to the point that it is affecting her breathing. She ha...

Dr. Chen Sirong reply Oncology
Ms. Yang: Hello. 1. Is the direction of the above suspicions correct? Are there any other possibilities that may not have been considered? The three most common organs affected by edema—heart, liver, and kidneys—are all functioning properly, so the physician has to look for oth...

Understanding Kidney Issues: A Comprehensive Guide for Patients and Families

Hello Doctor, My family member (female, 29 years old) has long-term chronic health issues. She has been diagnosed with refractory epilepsy for 23 years and is currently taking the following medications: Depakote 700mg, Vimpat 100mg, Keppra 1000mg, and Lamictal 30mg. Additionally...

Dr. Wu Hongjie reply Internal Medicine
Hello: Currently, your family member's creatinine levels have returned to normal range. The recent decline in kidney function is likely due to acute kidney injury, but regular monitoring is still necessary. Dietary restrictions are not required at this time. The exact causes...

Understanding Cardiac Arrest and Coma in Patients with Atrial Fibrillation

Dear Director Huang, I would like to ask you a few questions regarding a patient with atrial fibrillation who has a history of a mild hemorrhagic stroke in the basal ganglia several years ago. The patient was admitted to the intensive care unit due to myocardial infarction and p...

Dr. Huang Yingzhe reply Neurology
Dear Mr. Tsai, This is Dr. Huang Ying-Che, the Director of the Neurology Department at Tainan Hospital, Ministry of Health and Welfare. 1. It is possible that due to pre-existing stroke damage in the brain and renal failure, there are significant functional issues. 2. It is dif...