OBG Management

Although broad ligament fibroids are rare, their surgical management includes nuances of anatomical awareness, traction and counter-traction techniques, and proper hemostasis.

This month’s surgical video presents the case of a 40-year-old woman who presented to the emergency department with sudden-onset abdominal pain. She had a history of menorrhagia and dysmenorrhea and had undergone uterine artery embolization.

The objectives of this technique video are to provide:

I hope you find this video to be a useful tool for your practice and that you share it, and the other technique videos on my Video Channel, with your colleagues.

Vidyard Video

Although broad ligament fibroids are rare, their surgical management includes nuances of anatomical awareness, traction and counter-traction techniques, and proper hemostasis.

This month’s surgical video presents the case of a 40-year-old woman who presented to the emergency department with sudden-onset abdominal pain. She had a history of menorrhagia and dysmenorrhea and had undergone uterine artery embolization.

The objectives of this technique video are to provide:

I hope you find this video to be a useful tool for your practice and that you share it, and the other technique videos on my Video Channel, with your colleagues.

Vidyard Video

Although broad ligament fibroids are rare, their surgical management includes nuances of anatomical awareness, traction and counter-traction techniques, and proper hemostasis.

This month’s surgical video presents the case of a 40-year-old woman who presented to the emergency department with sudden-onset abdominal pain. She had a history of menorrhagia and dysmenorrhea and had undergone uterine artery embolization.

The objectives of this technique video are to provide:

I hope you find this video to be a useful tool for your practice and that you share it, and the other technique videos on my Video Channel, with your colleagues.

Vidyard Video

Web sites are not like wine and cheese—they don’t necessarily get better with age. You may have started your Web page 20 years ago by moving your 3-color trifold brochure onto the Internet. It may have worked then, but to compete today you must have a robust, interactive, attractive Web site that is continuously being updated with new content. What prospective patients are looking for in a Web site has evolved rapidly. How to get these patients to take action and call for an appointment requires a process or a system.

Trying to keep your Web site current can be daunting for most medical practices. If you find that your Web site is not generating new patients and that your existing patients are not using the site in an interactive fashion, then it is time to upgrade. In this article we suggest 5 practical ways to make your Web site a useful adjunct to your medical practice—an automatic patient conversion system.

1. Go mobile
Make your Web site “thumb friendly.” Mobile technology has taken over the desktop and laptop worlds. Now nearly everyone is using a hand-held smartphone or tablet for their Internet needs.

To attract patients your Web page must be responsive to the screen size of a smartphone or tablet—very different from your Web site, which is accessed from a desktop or a laptop computer. The majority of ­users navigate not with a mouse but with their fingers and thumbs. To ensure they can find their way on your Web page on a mobile device, the screen view should adjust automatically to the mobile device being used. Whether that is accomplished through a mobile responsive design or an entirely different mobile Web site, you do not want the user to have to resize, zoom, or pinch their way through the page in order to read the content. All the buttons must be large enough to be easily pressed without having to zoom in, and the font should be easy-to-read in style and size.

Having your current Web site programmed to be responsive to these devices will increase the time a mobile user spends on your site and make it easier for her to make an appointment.

2. Add patient reviews
What others say about you is far more important than anything you can say about yourself. Almost half of prospective patients will check out your online reviews before calling you to schedule an appointment.¹ Therefore, it is very important that you ask for positive feedback from your patients and post it to your Web site. We recommend that you capture compliments from your existing patients when they are in the office. Have a computer or iPad handy for them to create a positive review; patients who “promise” to do it when they get back to the office or home rarely follow through. Testimonials should be visible on your homepage and can link to another testimonial page or review site.

Always invite your patients to evaluate you, your practice partners, and the practice online. There are numerous patient review Web sites, including: Google Plus, http://www.RateMDs.com, http://www.Vitals.com, and http://www.HealthGrades.com. And check out what your patients are saying about you on a regular basis. Just type “Reviews for Dr. <your name>” into your search bar to find the results.

Although we hope they will, happy patients rarely fill out these online reviews. However, it takes just 2 or 3 unhappy patients to ruin your online reputation. That could be costing you tens of thousands of dollars in lost billing.

3. Share your videos
What’s hot and what’s not? To answer that, just take a look at how many people watch videos on YouTube every day! People don’t want to read anymore; they want to be entertained and spoon-fed information.

Take advantage of this trend by placing videos on your homepage. Post a video that introduces your practice, provides testimonials of satisfied patients, explains some of the procedures you perform, or shows you describing the latest breakthrough in medical technology.

Your videos don’t have to be long. One to 2 minutes is plenty. They don’t have to feature you talking about medical symptoms or procedures (what’s called a talking head video). Use a PowerPoint presentation with voice overlay—and you don’t have to be the one talking.

Your Web site isn’t the only place you’ll want to post your videos. YouTube is second only to Google as the most popular search engine.³ Just about everyone goes to YouTube to view videos on whatever interests them. See our April 2014 article, titled “Using the Internet in your practice. Part 2: Generating new patients using social media,” to learn more on getting started with YouTube.

Videos will improve your Web site rankings and will increase the time visitors spend on the site. When done properly—labeling the videos with relevant keywords, making the videos short, and presenting information in layman’s language with reasons why it is important to seek a professional if the viewer is experiencing these types of symptoms—they are a great way to convert visitors to patients.

4. Hook‘em on the homepage
If you want your Web site to create a favorable first impression, your homepage should reflect that positive impression. Remember, the homepage, as the face of your practice, is the first thing that a patient will see long before she picks up the phone or comes to the office.

A potential patient visiting your site will make a snap judgment within a few seconds. Think of your homepage as a highway billboard. There are about 3 seconds to make an impression and for a driver to decide whether or not she will exit the highway to buy gas or eat at a restaurant or even contact a business in the future by telephone or, most likely, online. A visit to your Web site has the same attraction timing. 

Your homepage must be attractive; provide useful, current information; and have pleasing graphics—all without requiring the visitor to scroll down too far. Your Web site is your opportunity to create a good first impression—an opportunity that won’t happen again.

Use compelling headlines with keyword-related content. You want to make sure you use keywords that a prospective patient might search for in a main headline and in the main body of your home­page. But patients are not the only ones who spot those key terms. Search engines also crawl your Web site for keywords that prospective patients may type into the Google search bar—words like gynecologist, ObGyn, urinary leakage, breast lump, pelvic pain, ­menopause, etc. Using those keywords helps your site to be found more often by patients and helps those prospective patients find information relevant to their medical needs.

5. Place calls to action on every page
Contact us! This is so rudimentary, yet many Web sites do not have easy-to-find contact information on their homepages. Be sure to include your phone number (which could be different than your regular phone office number so you can track how many calls you get from your Web site).

Add a “schedule an appointment” icon in a prominent position on the homepage so the visitor does not have to scroll down to search for it. But don’t just stop at the homepage. Your contact information should be on every page so that, when the visitor is on a page reading about a condition or procedure, the “schedule an appointment” button is right there for her to click.

Be sure to evaluate your contact page. Make sure it’s easy for patients to find multiple ways to connect with you and your office: phone, fax, email, and snail mail.

Interactivity is important. Why not have an “Ask the doctor your question” field? It makes the site interactive and gives you the opportunity to communicate and develop a relationship with your patients.

Additional interactivity
Social media is the new buzz word-of-mouth. Your patients use Facebook, YouTube, blogging, and Twitter every day. It is the easiest way to stay connected and make your practice and your brand part of their daily lives. Social media builds loyalty. Integrating social media into your Web site provides new opportunities to engage your existing patients and to attract new ones to your practice.  

Connect to medical records. Your Web site should have an easy portal for patients to connect to their medical records and laboratory results in a secure, encrypted fashion to comply with HIPAA regulations.

You can do this yourself!
You and your staff should be able to make changes on your Web site without having to contact your Web developer, even if you do not have full-time IT assistance. For example, in Dr. Baum’s practice, his support staff can add testimonials, content, and pictures without contacting the Web developer or knowing code.

Make sure that function is designed into your site and that your Web developer teaches you and your staff how to keep your site updated.

The bottom line
Web sites are like a farmer’s fence, they are always under construction. Merely having a Web site, regardless of the size, specialty, or location of your practice, is not enough. Be sure your site attracts, holds, and converts viewers into paying patients. We hope you will consider these 5 suggestions as a roadmap to develop a robust site, so that when you ask a patient who referred her to your practice, her answer will be “your Web site” or “the Internet.” This will bring cockles to your heart and bucks in your bank account.

Share your thoughts! Send your Letter to the Editor to rbarbieri@frontlinemedcom.com. Please include your name and the city and state in which you practice.

Web sites are not like wine and cheese—they don’t necessarily get better with age. You may have started your Web page 20 years ago by moving your 3-color trifold brochure onto the Internet. It may have worked then, but to compete today you must have a robust, interactive, attractive Web site that is continuously being updated with new content. What prospective patients are looking for in a Web site has evolved rapidly. How to get these patients to take action and call for an appointment requires a process or a system.

Trying to keep your Web site current can be daunting for most medical practices. If you find that your Web site is not generating new patients and that your existing patients are not using the site in an interactive fashion, then it is time to upgrade. In this article we suggest 5 practical ways to make your Web site a useful adjunct to your medical practice—an automatic patient conversion system.

1. Go mobile
Make your Web site “thumb friendly.” Mobile technology has taken over the desktop and laptop worlds. Now nearly everyone is using a hand-held smartphone or tablet for their Internet needs.

To attract patients your Web page must be responsive to the screen size of a smartphone or tablet—very different from your Web site, which is accessed from a desktop or a laptop computer. The majority of ­users navigate not with a mouse but with their fingers and thumbs. To ensure they can find their way on your Web page on a mobile device, the screen view should adjust automatically to the mobile device being used. Whether that is accomplished through a mobile responsive design or an entirely different mobile Web site, you do not want the user to have to resize, zoom, or pinch their way through the page in order to read the content. All the buttons must be large enough to be easily pressed without having to zoom in, and the font should be easy-to-read in style and size.

Having your current Web site programmed to be responsive to these devices will increase the time a mobile user spends on your site and make it easier for her to make an appointment.

2. Add patient reviews
What others say about you is far more important than anything you can say about yourself. Almost half of prospective patients will check out your online reviews before calling you to schedule an appointment.¹ Therefore, it is very important that you ask for positive feedback from your patients and post it to your Web site. We recommend that you capture compliments from your existing patients when they are in the office. Have a computer or iPad handy for them to create a positive review; patients who “promise” to do it when they get back to the office or home rarely follow through. Testimonials should be visible on your homepage and can link to another testimonial page or review site.

Always invite your patients to evaluate you, your practice partners, and the practice online. There are numerous patient review Web sites, including: Google Plus, http://www.RateMDs.com, http://www.Vitals.com, and http://www.HealthGrades.com. And check out what your patients are saying about you on a regular basis. Just type “Reviews for Dr. <your name>” into your search bar to find the results.

Although we hope they will, happy patients rarely fill out these online reviews. However, it takes just 2 or 3 unhappy patients to ruin your online reputation. That could be costing you tens of thousands of dollars in lost billing.

3. Share your videos
What’s hot and what’s not? To answer that, just take a look at how many people watch videos on YouTube every day! People don’t want to read anymore; they want to be entertained and spoon-fed information.

Take advantage of this trend by placing videos on your homepage. Post a video that introduces your practice, provides testimonials of satisfied patients, explains some of the procedures you perform, or shows you describing the latest breakthrough in medical technology.

Your videos don’t have to be long. One to 2 minutes is plenty. They don’t have to feature you talking about medical symptoms or procedures (what’s called a talking head video). Use a PowerPoint presentation with voice overlay—and you don’t have to be the one talking.

Your Web site isn’t the only place you’ll want to post your videos. YouTube is second only to Google as the most popular search engine.³ Just about everyone goes to YouTube to view videos on whatever interests them. See our April 2014 article, titled “Using the Internet in your practice. Part 2: Generating new patients using social media,” to learn more on getting started with YouTube.

Videos will improve your Web site rankings and will increase the time visitors spend on the site. When done properly—labeling the videos with relevant keywords, making the videos short, and presenting information in layman’s language with reasons why it is important to seek a professional if the viewer is experiencing these types of symptoms—they are a great way to convert visitors to patients.

4. Hook‘em on the homepage
If you want your Web site to create a favorable first impression, your homepage should reflect that positive impression. Remember, the homepage, as the face of your practice, is the first thing that a patient will see long before she picks up the phone or comes to the office.

A potential patient visiting your site will make a snap judgment within a few seconds. Think of your homepage as a highway billboard. There are about 3 seconds to make an impression and for a driver to decide whether or not she will exit the highway to buy gas or eat at a restaurant or even contact a business in the future by telephone or, most likely, online. A visit to your Web site has the same attraction timing. 

Your homepage must be attractive; provide useful, current information; and have pleasing graphics—all without requiring the visitor to scroll down too far. Your Web site is your opportunity to create a good first impression—an opportunity that won’t happen again.

Use compelling headlines with keyword-related content. You want to make sure you use keywords that a prospective patient might search for in a main headline and in the main body of your home­page. But patients are not the only ones who spot those key terms. Search engines also crawl your Web site for keywords that prospective patients may type into the Google search bar—words like gynecologist, ObGyn, urinary leakage, breast lump, pelvic pain, ­menopause, etc. Using those keywords helps your site to be found more often by patients and helps those prospective patients find information relevant to their medical needs.

5. Place calls to action on every page
Contact us! This is so rudimentary, yet many Web sites do not have easy-to-find contact information on their homepages. Be sure to include your phone number (which could be different than your regular phone office number so you can track how many calls you get from your Web site).

Add a “schedule an appointment” icon in a prominent position on the homepage so the visitor does not have to scroll down to search for it. But don’t just stop at the homepage. Your contact information should be on every page so that, when the visitor is on a page reading about a condition or procedure, the “schedule an appointment” button is right there for her to click.

Be sure to evaluate your contact page. Make sure it’s easy for patients to find multiple ways to connect with you and your office: phone, fax, email, and snail mail.

Interactivity is important. Why not have an “Ask the doctor your question” field? It makes the site interactive and gives you the opportunity to communicate and develop a relationship with your patients.

Additional interactivity
Social media is the new buzz word-of-mouth. Your patients use Facebook, YouTube, blogging, and Twitter every day. It is the easiest way to stay connected and make your practice and your brand part of their daily lives. Social media builds loyalty. Integrating social media into your Web site provides new opportunities to engage your existing patients and to attract new ones to your practice.  

Connect to medical records. Your Web site should have an easy portal for patients to connect to their medical records and laboratory results in a secure, encrypted fashion to comply with HIPAA regulations.

You can do this yourself!
You and your staff should be able to make changes on your Web site without having to contact your Web developer, even if you do not have full-time IT assistance. For example, in Dr. Baum’s practice, his support staff can add testimonials, content, and pictures without contacting the Web developer or knowing code.

Make sure that function is designed into your site and that your Web developer teaches you and your staff how to keep your site updated.

The bottom line
Web sites are like a farmer’s fence, they are always under construction. Merely having a Web site, regardless of the size, specialty, or location of your practice, is not enough. Be sure your site attracts, holds, and converts viewers into paying patients. We hope you will consider these 5 suggestions as a roadmap to develop a robust site, so that when you ask a patient who referred her to your practice, her answer will be “your Web site” or “the Internet.” This will bring cockles to your heart and bucks in your bank account.

Share your thoughts! Send your Letter to the Editor to rbarbieri@frontlinemedcom.com. Please include your name and the city and state in which you practice.

Web sites are not like wine and cheese—they don’t necessarily get better with age. You may have started your Web page 20 years ago by moving your 3-color trifold brochure onto the Internet. It may have worked then, but to compete today you must have a robust, interactive, attractive Web site that is continuously being updated with new content. What prospective patients are looking for in a Web site has evolved rapidly. How to get these patients to take action and call for an appointment requires a process or a system.

Trying to keep your Web site current can be daunting for most medical practices. If you find that your Web site is not generating new patients and that your existing patients are not using the site in an interactive fashion, then it is time to upgrade. In this article we suggest 5 practical ways to make your Web site a useful adjunct to your medical practice—an automatic patient conversion system.

1. Go mobile
Make your Web site “thumb friendly.” Mobile technology has taken over the desktop and laptop worlds. Now nearly everyone is using a hand-held smartphone or tablet for their Internet needs.

To attract patients your Web page must be responsive to the screen size of a smartphone or tablet—very different from your Web site, which is accessed from a desktop or a laptop computer. The majority of ­users navigate not with a mouse but with their fingers and thumbs. To ensure they can find their way on your Web page on a mobile device, the screen view should adjust automatically to the mobile device being used. Whether that is accomplished through a mobile responsive design or an entirely different mobile Web site, you do not want the user to have to resize, zoom, or pinch their way through the page in order to read the content. All the buttons must be large enough to be easily pressed without having to zoom in, and the font should be easy-to-read in style and size.

Having your current Web site programmed to be responsive to these devices will increase the time a mobile user spends on your site and make it easier for her to make an appointment.

2. Add patient reviews
What others say about you is far more important than anything you can say about yourself. Almost half of prospective patients will check out your online reviews before calling you to schedule an appointment.¹ Therefore, it is very important that you ask for positive feedback from your patients and post it to your Web site. We recommend that you capture compliments from your existing patients when they are in the office. Have a computer or iPad handy for them to create a positive review; patients who “promise” to do it when they get back to the office or home rarely follow through. Testimonials should be visible on your homepage and can link to another testimonial page or review site.

Always invite your patients to evaluate you, your practice partners, and the practice online. There are numerous patient review Web sites, including: Google Plus, http://www.RateMDs.com, http://www.Vitals.com, and http://www.HealthGrades.com. And check out what your patients are saying about you on a regular basis. Just type “Reviews for Dr. <your name>” into your search bar to find the results.

Although we hope they will, happy patients rarely fill out these online reviews. However, it takes just 2 or 3 unhappy patients to ruin your online reputation. That could be costing you tens of thousands of dollars in lost billing.

3. Share your videos
What’s hot and what’s not? To answer that, just take a look at how many people watch videos on YouTube every day! People don’t want to read anymore; they want to be entertained and spoon-fed information.

Take advantage of this trend by placing videos on your homepage. Post a video that introduces your practice, provides testimonials of satisfied patients, explains some of the procedures you perform, or shows you describing the latest breakthrough in medical technology.

Your videos don’t have to be long. One to 2 minutes is plenty. They don’t have to feature you talking about medical symptoms or procedures (what’s called a talking head video). Use a PowerPoint presentation with voice overlay—and you don’t have to be the one talking.

Your Web site isn’t the only place you’ll want to post your videos. YouTube is second only to Google as the most popular search engine.³ Just about everyone goes to YouTube to view videos on whatever interests them. See our April 2014 article, titled “Using the Internet in your practice. Part 2: Generating new patients using social media,” to learn more on getting started with YouTube.

Videos will improve your Web site rankings and will increase the time visitors spend on the site. When done properly—labeling the videos with relevant keywords, making the videos short, and presenting information in layman’s language with reasons why it is important to seek a professional if the viewer is experiencing these types of symptoms—they are a great way to convert visitors to patients.

4. Hook‘em on the homepage
If you want your Web site to create a favorable first impression, your homepage should reflect that positive impression. Remember, the homepage, as the face of your practice, is the first thing that a patient will see long before she picks up the phone or comes to the office.

A potential patient visiting your site will make a snap judgment within a few seconds. Think of your homepage as a highway billboard. There are about 3 seconds to make an impression and for a driver to decide whether or not she will exit the highway to buy gas or eat at a restaurant or even contact a business in the future by telephone or, most likely, online. A visit to your Web site has the same attraction timing. 

Your homepage must be attractive; provide useful, current information; and have pleasing graphics—all without requiring the visitor to scroll down too far. Your Web site is your opportunity to create a good first impression—an opportunity that won’t happen again.

Use compelling headlines with keyword-related content. You want to make sure you use keywords that a prospective patient might search for in a main headline and in the main body of your home­page. But patients are not the only ones who spot those key terms. Search engines also crawl your Web site for keywords that prospective patients may type into the Google search bar—words like gynecologist, ObGyn, urinary leakage, breast lump, pelvic pain, ­menopause, etc. Using those keywords helps your site to be found more often by patients and helps those prospective patients find information relevant to their medical needs.

5. Place calls to action on every page
Contact us! This is so rudimentary, yet many Web sites do not have easy-to-find contact information on their homepages. Be sure to include your phone number (which could be different than your regular phone office number so you can track how many calls you get from your Web site).

Add a “schedule an appointment” icon in a prominent position on the homepage so the visitor does not have to scroll down to search for it. But don’t just stop at the homepage. Your contact information should be on every page so that, when the visitor is on a page reading about a condition or procedure, the “schedule an appointment” button is right there for her to click.

Be sure to evaluate your contact page. Make sure it’s easy for patients to find multiple ways to connect with you and your office: phone, fax, email, and snail mail.

Interactivity is important. Why not have an “Ask the doctor your question” field? It makes the site interactive and gives you the opportunity to communicate and develop a relationship with your patients.

Additional interactivity
Social media is the new buzz word-of-mouth. Your patients use Facebook, YouTube, blogging, and Twitter every day. It is the easiest way to stay connected and make your practice and your brand part of their daily lives. Social media builds loyalty. Integrating social media into your Web site provides new opportunities to engage your existing patients and to attract new ones to your practice.  

Connect to medical records. Your Web site should have an easy portal for patients to connect to their medical records and laboratory results in a secure, encrypted fashion to comply with HIPAA regulations.

You can do this yourself!
You and your staff should be able to make changes on your Web site without having to contact your Web developer, even if you do not have full-time IT assistance. For example, in Dr. Baum’s practice, his support staff can add testimonials, content, and pictures without contacting the Web developer or knowing code.

Make sure that function is designed into your site and that your Web developer teaches you and your staff how to keep your site updated.

The bottom line
Web sites are like a farmer’s fence, they are always under construction. Merely having a Web site, regardless of the size, specialty, or location of your practice, is not enough. Be sure your site attracts, holds, and converts viewers into paying patients. We hope you will consider these 5 suggestions as a roadmap to develop a robust site, so that when you ask a patient who referred her to your practice, her answer will be “your Web site” or “the Internet.” This will bring cockles to your heart and bucks in your bank account.

Share your thoughts! Send your Letter to the Editor to rbarbieri@frontlinemedcom.com. Please include your name and the city and state in which you practice.

Mother dies after cesarean delivery: $4.5M verdict
A 31-year-old woman gave birth to her first child by cesarean delivery. Over the next 3 days she reported nausea, vomiting, severe abdominal pain, and had an elevated heart rate. On day 4, she was discharged from the hospital. She went to the ObGyn’s office the next day and was told, after several hours, to return to the hospital. There she was found to have sepsis and acute renal failure. A transfer to another hospital was attempted that night, but she died during transport. 

Estate's Claim: The ObGyn should have responded to her reported symptoms prior to discharge by ordering tests. The ObGyn should have called an ambulance to transport her to the hospital from his office.

Defendants’ Defense: The hospital settled for an undisclosed amount before the trial. The ObGyn claimed that there was no negligence in the patient’s treatment.

Verdict: A $4.5 million North Carolina verdict was returned.

Brain-damaged child dies at age 2
A woman was admitted to the hospital in labor. Ninety minutes later a nonreassuring fetal heart-rate tracing was noted. Two hours after that, the ObGyn decided to perform an emergency cesarean delivery.

The child was depressed at birth and required resuscitation. She was transferred to another hospital’s neonatal intensive care unit (NICU), where she was found to have had a severe and catastrophic brain injury. The child died at 2 years of age. 

Parent's Claim: An emergency cesarean delivery should have been performed as soon as the fetal heart-rate tracing was found to be nonreassuring. The ObGyn failed to respond to phone calls from the nurses to report fetal distress.

Physician's Defense: The delivery was performed in a timely manner. Brain damage was due to encephalopathy that occurred prior to labor.

Verdict: A Mississippi defense verdict was returned.

Who or what was at fault for ureter injury?
A 45-year-old woman underwent hysterectomy performed by her ObGyn. During surgery, the patient’s ureter was injured. Several additional operations were needed to repair the injury. 

Patient's Claim: The patient was not fully informed of the extent of the surgery or possible complications. The ObGyn was negligent in injuring the ureter.

Defendants' Defense: Three months after surgery, the physician entered notes into the patient’s chart that indicated that the ureter injuries were due to a defective monopolar device that had been provided by the hospital. Informed consent included surgical options and complications.

The hospital argued that its equipment was not defective; other surgeons had used the device without any problems. The ObGyn had not used the device before; any injuries were due to his inexperience and negligence.

Verdict: A $2 million South Carolina verdict was returned against the ObGyn. The hospital received a defense verdict.

Did excessive force cause child’s C7 injury?
During delivery, shoulder dystocia was encountered. The child has nerve root avulsion at C7 with damage to adjacent nerve trunks at C5–C6. As a result of the brachial plexus injury, the patient underwent cable grafting and muscle surgeries, but he has permanent weakness and dysfunction in his left arm. 

Parent's Claim: Excessive force was used to deliver the child during manipulations for shoulder dystocia.

Physician's Defense: The ObGyn denied using excessive traction. She claimed that she had never used upward traction during a shoulder dystocia presentation. Suprapubic pressure, McRoberts’ maneuver, and delivery of the posterior arm were used. The damage occurred prior to delivery of the head.

Verdict An Illinois defense verdict was returned.

 

Laparoscopic sheath and coils found at exploratory surgery
In april 2007, a woman underwent a sterilization procedure (Essure) after which she reported pelvic pain. In September 2007, she consented to right salpingo-oophorectomy plus appendectomy. The ObGyn performed the surgery using a robotic device. After surgery, the pathology report indicated that the resected organs were normal and functional.

The patient moved to another state. She continued to have pain and sought treatment with another physician. A computed tomography (CT) scan more than 3 years after robotic surgery revealed foreign objects in the patient’s body. One full Essure coil, a non-fired coil, a second partial coil, and a robotic laparoscopy sheath were surgically removed.

Patient's Claim: The ObGyn was negligent in the performance of the sterilization and robotic surgery procedures. The healthy ovary and fallopian tube should not have been removed and caused her to have surgical menopause.

Physician's defense: The right ovary appeared diseased. The Essure device dropped the coils. The robot malfunctioned during the salpingo-oophorectomy. 

Verdict: A $110,513 Oregon verdict was returned, including $10,500 in medical expenses and $100,000 for pain and mental anguish.

Discrepancy in fundal height; child has CP
During her second pregnancy, a 37-year-old woman saw Dr. A, her ObGyn, for regular prenatal care. At 37 weeks’ gestation, the fundal height was not consistent with the fetus’ gestational age: the measurement was higher by 2 cm. No additional testing was scheduled.

At 39.5 weeks’ gestation, the mother reported decreased fetal movement. Because her regular ObGyn was on vacation, she was evaluated by another ObGyn (Dr. B). The fetal heart-rate monitor showed nonreactive results with minimal variability. Dr. B told the mother to drive herself to the emergency department (ED) for additional evaluation. At the hospital, when fetal heart-rate monitoring confirmed fetal distress, an emergency cesarean delivery was performed.

At birth, the baby was not breathing and resuscitation began. The infant was taken to a transitional care unit and then to the NICU, where he was intubated. Cord blood testing confirmed metabolic acidosis. The baby was later found to have dystonic cerebral palsy (CP). He is unable to speak, walk, eat, or care for himself, and he requires 24/7 nursing care. 

Parents' Claim: Dr. A failed to order testing after the fundal height discrepancy was found. Testing could have led to an earlier delivery and avoided the injury. The pediatrician failed to ensure adequate oxygenation after delivery. The baby should have been transferred immediately to the NICU and intubated.

Physician's Defense: The fundal height discrepancy was explained by the baby’s position within the uterus. The pediatrician acted heroically to save the child’s life.

Verdict: A $3.5 million Massachusetts settlement was reached.

NT scans misread, not reported; child has Down syndrome
At 13 weeks’ gestation, a 38-year-old woman saw a maternal-fetal medicine (MFM) specialist, who interpreted a nuchal translucency (NT) scan as normal. At 20 weeks’ gestation, an ObGyn performed a second screening that indicated the fetus was at high risk for Down syndrome. However, no further testing was ordered.

At 26.5 weeks’ gestation, amniocentesis was performed after ultrasonography and an echocardiogram revealed fetal abnormalities. A diagnosis of Down syndrome was made at 29 weeks’ gestation, too late for termination of pregnancy. 

Parent's Claim: The MFM specialist misread the first NT scan. The ObGyn did not inform the mother of the results of the second screening. Proper interpretation and reporting would have initiated further testing and determination that the baby had Down syndrome before the deadline for termination of pregnancy.

Defendants' Defense: The case was settled during trial.

Verdict: A $3 million New Jersey settlement was reached, including $2 million from the medical center where the second test was performed, $940,000 from the ObGyn, and $60,000 from the MFM specialist.

Uterine rupture, baby dies: $2.15M award
At 38 weeks’ gestation, a mother was admitted to a hospital for induction of labor due to pregnancy-induced hypertension. The fetus was estimated to be large for its gestational age. A uterine rupture occurred during labor. The baby was stillborn.

Parents' Claim: The uterine rupture was not immediately recognized. The ObGyn failed to come to the mother’s bedside until after the fetus had receded up the birth canal, which indicated that a rupture was occurring. The ObGyn ordered oxytocin instead of performing an immediate cesarean delivery. Eleven minutes later, the cesarean was ordered, but the baby had died.

Physician's Defense: There was no negligence; proper protocols were followed. A uterine rupture cannot be predicted.

Verdict: A $650,000 settlement was reached with the hospital before trial. Because the ObGyn was employed by a federally qualified clinic, the matter was filed in federal court. The Illinois court issued a bench decision awarding $1.5 million.

Migrated IUD causes years of pain
In september 2006, an ObGyn inserted an intrauterine device (IUD) in a patient. In February 2007, the patient had an ectopic pregnancy. The IUD was not found during dilation and curettage. The patient continued to report pain to the ObGyn. She sought treatment from another physician in November 2010 due to continuing pain. A CT scan revealed that the IUD had migrated to her abdomen. The IUD was surgically removed.

Patient's Claim: The ObGyn was unwilling to figure out why the patient had continuing pain, and told her to “just deal with it.” He should have found and removed the IUD after the ectopic pregnancy.

Physician's Defense: It was reasonable to assume that the IUD had been expelled, as 2 ultrasonographies performed after ectopic pregnancy revealed nothing. Since the IUD had not caused an abscess, infection, or inflammation, the patient suffered no injury.

Verdict: A Virginia defense verdict was returned.

Profoundly disabled child dies at age 5
A 17-year-old woman with a history of miscarriage received prenatal care from her ObGyn. A July due date was established by ultrasonography in January.

In May, the mother went to the ED with pelvic pain. She was treated for preterm labor and discharged 2 days later.

In early July, ultrasonography showed a fetus in cephalic position with a posterior-located placenta.

At a prenatal examination a week later, the patient reported vaginal discharge. Her ObGyn suspected premature rupture of membranes (PROM) and admitted her to the hospital. Oxytocin was used to induce labor. Intact membranes were artificially ruptured and an internal fetal heart-rate monitor was placed. The ObGyn recorded that the pregnancy was at term.

Hours later, the mother told the nurses that she thought the fetal monitor had become disconnected; the monitor’s placement was not confirmed. The mother was given a sedative. After a few hours, she awoke with intense pain and dizziness. She used her call button, but no one immediately responded.

When full cervical dilation was reached, the fetus was at –1, 0 station. When the fetus reached +1 station, delivery was attempted. The baby was delivered using vacuum extraction.

The child’s Apgar score was 0 at 1 minute of life. Resuscitation was started with intubation and mechanical ventilation. The child’s birth weight was 6.87 lb; arterial blood gas pH measured 6.9; and gestational age was estimated at 38 to 39 weeks.

An electro-encephalogram performed in the NICU suggested intraventricular hemorrhage. The child was found to have perinatal asphyxia, hypoxic ischemic encephalopathy, left parietal skull fracture and cephalohematoma, severe metabolic acidosis, suspected sepsis, transient oliguria, and seizure episodes. The baby was hospitalized for 3.5 months and then followed regularly.

The mother and child moved from Puerto Rico to New York City to obtain better medical care. The child was regularly hospitalized until she died at age 5. 

Parent's Claim: There was a discrepancy in gestational age assessment. The nurses failed to monitor fetal heart-rate tracings at proper intervals, and they were unresponsive to the mother. Informed consent did not include vacuum extraction.

Defendants' Defense: The case was settled during trial.

Verdict: A $1.125 million Puerto Rico settlement was reached.

These cases were selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements, & Experts, with permission of the editor, Lewis Laska (www.verdictslaska.com). The information available to the editors about the cases presented here is sometimes incomplete. Moreover, the cases may or may not have merit. Nevertheless, these cases represent the types of clinical situations that typically result in litigation and are meant to illustrate nationwide variation in jury verdicts and awards.

Share your thoughts! Send your Letter to the Editor to rbarbieri@frontlinemedcom.com. Please include your name and the city and state in which you practice.

Mother dies after cesarean delivery: $4.5M verdict
A 31-year-old woman gave birth to her first child by cesarean delivery. Over the next 3 days she reported nausea, vomiting, severe abdominal pain, and had an elevated heart rate. On day 4, she was discharged from the hospital. She went to the ObGyn’s office the next day and was told, after several hours, to return to the hospital. There she was found to have sepsis and acute renal failure. A transfer to another hospital was attempted that night, but she died during transport. 

Estate's Claim: The ObGyn should have responded to her reported symptoms prior to discharge by ordering tests. The ObGyn should have called an ambulance to transport her to the hospital from his office.

Defendants’ Defense: The hospital settled for an undisclosed amount before the trial. The ObGyn claimed that there was no negligence in the patient’s treatment.

Verdict: A $4.5 million North Carolina verdict was returned.

Brain-damaged child dies at age 2
A woman was admitted to the hospital in labor. Ninety minutes later a nonreassuring fetal heart-rate tracing was noted. Two hours after that, the ObGyn decided to perform an emergency cesarean delivery.

The child was depressed at birth and required resuscitation. She was transferred to another hospital’s neonatal intensive care unit (NICU), where she was found to have had a severe and catastrophic brain injury. The child died at 2 years of age. 

Parent's Claim: An emergency cesarean delivery should have been performed as soon as the fetal heart-rate tracing was found to be nonreassuring. The ObGyn failed to respond to phone calls from the nurses to report fetal distress.

Physician's Defense: The delivery was performed in a timely manner. Brain damage was due to encephalopathy that occurred prior to labor.

Verdict: A Mississippi defense verdict was returned.

Who or what was at fault for ureter injury?
A 45-year-old woman underwent hysterectomy performed by her ObGyn. During surgery, the patient’s ureter was injured. Several additional operations were needed to repair the injury. 

Patient's Claim: The patient was not fully informed of the extent of the surgery or possible complications. The ObGyn was negligent in injuring the ureter.

Defendants' Defense: Three months after surgery, the physician entered notes into the patient’s chart that indicated that the ureter injuries were due to a defective monopolar device that had been provided by the hospital. Informed consent included surgical options and complications.

The hospital argued that its equipment was not defective; other surgeons had used the device without any problems. The ObGyn had not used the device before; any injuries were due to his inexperience and negligence.

Verdict: A $2 million South Carolina verdict was returned against the ObGyn. The hospital received a defense verdict.

Did excessive force cause child’s C7 injury?
During delivery, shoulder dystocia was encountered. The child has nerve root avulsion at C7 with damage to adjacent nerve trunks at C5–C6. As a result of the brachial plexus injury, the patient underwent cable grafting and muscle surgeries, but he has permanent weakness and dysfunction in his left arm. 

Parent's Claim: Excessive force was used to deliver the child during manipulations for shoulder dystocia.

Physician's Defense: The ObGyn denied using excessive traction. She claimed that she had never used upward traction during a shoulder dystocia presentation. Suprapubic pressure, McRoberts’ maneuver, and delivery of the posterior arm were used. The damage occurred prior to delivery of the head.

Verdict An Illinois defense verdict was returned.

 

Laparoscopic sheath and coils found at exploratory surgery
In april 2007, a woman underwent a sterilization procedure (Essure) after which she reported pelvic pain. In September 2007, she consented to right salpingo-oophorectomy plus appendectomy. The ObGyn performed the surgery using a robotic device. After surgery, the pathology report indicated that the resected organs were normal and functional.

The patient moved to another state. She continued to have pain and sought treatment with another physician. A computed tomography (CT) scan more than 3 years after robotic surgery revealed foreign objects in the patient’s body. One full Essure coil, a non-fired coil, a second partial coil, and a robotic laparoscopy sheath were surgically removed.

Patient's Claim: The ObGyn was negligent in the performance of the sterilization and robotic surgery procedures. The healthy ovary and fallopian tube should not have been removed and caused her to have surgical menopause.

Physician's defense: The right ovary appeared diseased. The Essure device dropped the coils. The robot malfunctioned during the salpingo-oophorectomy. 

Verdict: A $110,513 Oregon verdict was returned, including $10,500 in medical expenses and $100,000 for pain and mental anguish.

Discrepancy in fundal height; child has CP
During her second pregnancy, a 37-year-old woman saw Dr. A, her ObGyn, for regular prenatal care. At 37 weeks’ gestation, the fundal height was not consistent with the fetus’ gestational age: the measurement was higher by 2 cm. No additional testing was scheduled.

At 39.5 weeks’ gestation, the mother reported decreased fetal movement. Because her regular ObGyn was on vacation, she was evaluated by another ObGyn (Dr. B). The fetal heart-rate monitor showed nonreactive results with minimal variability. Dr. B told the mother to drive herself to the emergency department (ED) for additional evaluation. At the hospital, when fetal heart-rate monitoring confirmed fetal distress, an emergency cesarean delivery was performed.

At birth, the baby was not breathing and resuscitation began. The infant was taken to a transitional care unit and then to the NICU, where he was intubated. Cord blood testing confirmed metabolic acidosis. The baby was later found to have dystonic cerebral palsy (CP). He is unable to speak, walk, eat, or care for himself, and he requires 24/7 nursing care. 

Parents' Claim: Dr. A failed to order testing after the fundal height discrepancy was found. Testing could have led to an earlier delivery and avoided the injury. The pediatrician failed to ensure adequate oxygenation after delivery. The baby should have been transferred immediately to the NICU and intubated.

Physician's Defense: The fundal height discrepancy was explained by the baby’s position within the uterus. The pediatrician acted heroically to save the child’s life.

Verdict: A $3.5 million Massachusetts settlement was reached.

NT scans misread, not reported; child has Down syndrome
At 13 weeks’ gestation, a 38-year-old woman saw a maternal-fetal medicine (MFM) specialist, who interpreted a nuchal translucency (NT) scan as normal. At 20 weeks’ gestation, an ObGyn performed a second screening that indicated the fetus was at high risk for Down syndrome. However, no further testing was ordered.

At 26.5 weeks’ gestation, amniocentesis was performed after ultrasonography and an echocardiogram revealed fetal abnormalities. A diagnosis of Down syndrome was made at 29 weeks’ gestation, too late for termination of pregnancy. 

Parent's Claim: The MFM specialist misread the first NT scan. The ObGyn did not inform the mother of the results of the second screening. Proper interpretation and reporting would have initiated further testing and determination that the baby had Down syndrome before the deadline for termination of pregnancy.

Defendants' Defense: The case was settled during trial.

Verdict: A $3 million New Jersey settlement was reached, including $2 million from the medical center where the second test was performed, $940,000 from the ObGyn, and $60,000 from the MFM specialist.

Uterine rupture, baby dies: $2.15M award
At 38 weeks’ gestation, a mother was admitted to a hospital for induction of labor due to pregnancy-induced hypertension. The fetus was estimated to be large for its gestational age. A uterine rupture occurred during labor. The baby was stillborn.

Parents' Claim: The uterine rupture was not immediately recognized. The ObGyn failed to come to the mother’s bedside until after the fetus had receded up the birth canal, which indicated that a rupture was occurring. The ObGyn ordered oxytocin instead of performing an immediate cesarean delivery. Eleven minutes later, the cesarean was ordered, but the baby had died.

Physician's Defense: There was no negligence; proper protocols were followed. A uterine rupture cannot be predicted.

Verdict: A $650,000 settlement was reached with the hospital before trial. Because the ObGyn was employed by a federally qualified clinic, the matter was filed in federal court. The Illinois court issued a bench decision awarding $1.5 million.

Migrated IUD causes years of pain
In september 2006, an ObGyn inserted an intrauterine device (IUD) in a patient. In February 2007, the patient had an ectopic pregnancy. The IUD was not found during dilation and curettage. The patient continued to report pain to the ObGyn. She sought treatment from another physician in November 2010 due to continuing pain. A CT scan revealed that the IUD had migrated to her abdomen. The IUD was surgically removed.

Patient's Claim: The ObGyn was unwilling to figure out why the patient had continuing pain, and told her to “just deal with it.” He should have found and removed the IUD after the ectopic pregnancy.

Physician's Defense: It was reasonable to assume that the IUD had been expelled, as 2 ultrasonographies performed after ectopic pregnancy revealed nothing. Since the IUD had not caused an abscess, infection, or inflammation, the patient suffered no injury.

Verdict: A Virginia defense verdict was returned.

Profoundly disabled child dies at age 5
A 17-year-old woman with a history of miscarriage received prenatal care from her ObGyn. A July due date was established by ultrasonography in January.

In May, the mother went to the ED with pelvic pain. She was treated for preterm labor and discharged 2 days later.

In early July, ultrasonography showed a fetus in cephalic position with a posterior-located placenta.

At a prenatal examination a week later, the patient reported vaginal discharge. Her ObGyn suspected premature rupture of membranes (PROM) and admitted her to the hospital. Oxytocin was used to induce labor. Intact membranes were artificially ruptured and an internal fetal heart-rate monitor was placed. The ObGyn recorded that the pregnancy was at term.

Hours later, the mother told the nurses that she thought the fetal monitor had become disconnected; the monitor’s placement was not confirmed. The mother was given a sedative. After a few hours, she awoke with intense pain and dizziness. She used her call button, but no one immediately responded.

When full cervical dilation was reached, the fetus was at –1, 0 station. When the fetus reached +1 station, delivery was attempted. The baby was delivered using vacuum extraction.

The child’s Apgar score was 0 at 1 minute of life. Resuscitation was started with intubation and mechanical ventilation. The child’s birth weight was 6.87 lb; arterial blood gas pH measured 6.9; and gestational age was estimated at 38 to 39 weeks.

An electro-encephalogram performed in the NICU suggested intraventricular hemorrhage. The child was found to have perinatal asphyxia, hypoxic ischemic encephalopathy, left parietal skull fracture and cephalohematoma, severe metabolic acidosis, suspected sepsis, transient oliguria, and seizure episodes. The baby was hospitalized for 3.5 months and then followed regularly.

The mother and child moved from Puerto Rico to New York City to obtain better medical care. The child was regularly hospitalized until she died at age 5. 

Parent's Claim: There was a discrepancy in gestational age assessment. The nurses failed to monitor fetal heart-rate tracings at proper intervals, and they were unresponsive to the mother. Informed consent did not include vacuum extraction.

Defendants' Defense: The case was settled during trial.

Verdict: A $1.125 million Puerto Rico settlement was reached.

These cases were selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements, & Experts, with permission of the editor, Lewis Laska (www.verdictslaska.com). The information available to the editors about the cases presented here is sometimes incomplete. Moreover, the cases may or may not have merit. Nevertheless, these cases represent the types of clinical situations that typically result in litigation and are meant to illustrate nationwide variation in jury verdicts and awards.

Share your thoughts! Send your Letter to the Editor to rbarbieri@frontlinemedcom.com. Please include your name and the city and state in which you practice.

Mother dies after cesarean delivery: $4.5M verdict
A 31-year-old woman gave birth to her first child by cesarean delivery. Over the next 3 days she reported nausea, vomiting, severe abdominal pain, and had an elevated heart rate. On day 4, she was discharged from the hospital. She went to the ObGyn’s office the next day and was told, after several hours, to return to the hospital. There she was found to have sepsis and acute renal failure. A transfer to another hospital was attempted that night, but she died during transport. 

Estate's Claim: The ObGyn should have responded to her reported symptoms prior to discharge by ordering tests. The ObGyn should have called an ambulance to transport her to the hospital from his office.

Defendants’ Defense: The hospital settled for an undisclosed amount before the trial. The ObGyn claimed that there was no negligence in the patient’s treatment.

Verdict: A $4.5 million North Carolina verdict was returned.

Brain-damaged child dies at age 2
A woman was admitted to the hospital in labor. Ninety minutes later a nonreassuring fetal heart-rate tracing was noted. Two hours after that, the ObGyn decided to perform an emergency cesarean delivery.

The child was depressed at birth and required resuscitation. She was transferred to another hospital’s neonatal intensive care unit (NICU), where she was found to have had a severe and catastrophic brain injury. The child died at 2 years of age. 

Parent's Claim: An emergency cesarean delivery should have been performed as soon as the fetal heart-rate tracing was found to be nonreassuring. The ObGyn failed to respond to phone calls from the nurses to report fetal distress.

Physician's Defense: The delivery was performed in a timely manner. Brain damage was due to encephalopathy that occurred prior to labor.

Verdict: A Mississippi defense verdict was returned.

Who or what was at fault for ureter injury?
A 45-year-old woman underwent hysterectomy performed by her ObGyn. During surgery, the patient’s ureter was injured. Several additional operations were needed to repair the injury. 

Patient's Claim: The patient was not fully informed of the extent of the surgery or possible complications. The ObGyn was negligent in injuring the ureter.

Defendants' Defense: Three months after surgery, the physician entered notes into the patient’s chart that indicated that the ureter injuries were due to a defective monopolar device that had been provided by the hospital. Informed consent included surgical options and complications.

The hospital argued that its equipment was not defective; other surgeons had used the device without any problems. The ObGyn had not used the device before; any injuries were due to his inexperience and negligence.

Verdict: A $2 million South Carolina verdict was returned against the ObGyn. The hospital received a defense verdict.

Did excessive force cause child’s C7 injury?
During delivery, shoulder dystocia was encountered. The child has nerve root avulsion at C7 with damage to adjacent nerve trunks at C5–C6. As a result of the brachial plexus injury, the patient underwent cable grafting and muscle surgeries, but he has permanent weakness and dysfunction in his left arm. 

Parent's Claim: Excessive force was used to deliver the child during manipulations for shoulder dystocia.

Physician's Defense: The ObGyn denied using excessive traction. She claimed that she had never used upward traction during a shoulder dystocia presentation. Suprapubic pressure, McRoberts’ maneuver, and delivery of the posterior arm were used. The damage occurred prior to delivery of the head.

Verdict An Illinois defense verdict was returned.

 

Laparoscopic sheath and coils found at exploratory surgery
In april 2007, a woman underwent a sterilization procedure (Essure) after which she reported pelvic pain. In September 2007, she consented to right salpingo-oophorectomy plus appendectomy. The ObGyn performed the surgery using a robotic device. After surgery, the pathology report indicated that the resected organs were normal and functional.

The patient moved to another state. She continued to have pain and sought treatment with another physician. A computed tomography (CT) scan more than 3 years after robotic surgery revealed foreign objects in the patient’s body. One full Essure coil, a non-fired coil, a second partial coil, and a robotic laparoscopy sheath were surgically removed.

Patient's Claim: The ObGyn was negligent in the performance of the sterilization and robotic surgery procedures. The healthy ovary and fallopian tube should not have been removed and caused her to have surgical menopause.

Physician's defense: The right ovary appeared diseased. The Essure device dropped the coils. The robot malfunctioned during the salpingo-oophorectomy. 

Verdict: A $110,513 Oregon verdict was returned, including $10,500 in medical expenses and $100,000 for pain and mental anguish.

Discrepancy in fundal height; child has CP
During her second pregnancy, a 37-year-old woman saw Dr. A, her ObGyn, for regular prenatal care. At 37 weeks’ gestation, the fundal height was not consistent with the fetus’ gestational age: the measurement was higher by 2 cm. No additional testing was scheduled.

At 39.5 weeks’ gestation, the mother reported decreased fetal movement. Because her regular ObGyn was on vacation, she was evaluated by another ObGyn (Dr. B). The fetal heart-rate monitor showed nonreactive results with minimal variability. Dr. B told the mother to drive herself to the emergency department (ED) for additional evaluation. At the hospital, when fetal heart-rate monitoring confirmed fetal distress, an emergency cesarean delivery was performed.

At birth, the baby was not breathing and resuscitation began. The infant was taken to a transitional care unit and then to the NICU, where he was intubated. Cord blood testing confirmed metabolic acidosis. The baby was later found to have dystonic cerebral palsy (CP). He is unable to speak, walk, eat, or care for himself, and he requires 24/7 nursing care. 

Parents' Claim: Dr. A failed to order testing after the fundal height discrepancy was found. Testing could have led to an earlier delivery and avoided the injury. The pediatrician failed to ensure adequate oxygenation after delivery. The baby should have been transferred immediately to the NICU and intubated.

Physician's Defense: The fundal height discrepancy was explained by the baby’s position within the uterus. The pediatrician acted heroically to save the child’s life.

Verdict: A $3.5 million Massachusetts settlement was reached.

NT scans misread, not reported; child has Down syndrome
At 13 weeks’ gestation, a 38-year-old woman saw a maternal-fetal medicine (MFM) specialist, who interpreted a nuchal translucency (NT) scan as normal. At 20 weeks’ gestation, an ObGyn performed a second screening that indicated the fetus was at high risk for Down syndrome. However, no further testing was ordered.

At 26.5 weeks’ gestation, amniocentesis was performed after ultrasonography and an echocardiogram revealed fetal abnormalities. A diagnosis of Down syndrome was made at 29 weeks’ gestation, too late for termination of pregnancy. 

Parent's Claim: The MFM specialist misread the first NT scan. The ObGyn did not inform the mother of the results of the second screening. Proper interpretation and reporting would have initiated further testing and determination that the baby had Down syndrome before the deadline for termination of pregnancy.

Defendants' Defense: The case was settled during trial.

Verdict: A $3 million New Jersey settlement was reached, including $2 million from the medical center where the second test was performed, $940,000 from the ObGyn, and $60,000 from the MFM specialist.

Uterine rupture, baby dies: $2.15M award
At 38 weeks’ gestation, a mother was admitted to a hospital for induction of labor due to pregnancy-induced hypertension. The fetus was estimated to be large for its gestational age. A uterine rupture occurred during labor. The baby was stillborn.

Parents' Claim: The uterine rupture was not immediately recognized. The ObGyn failed to come to the mother’s bedside until after the fetus had receded up the birth canal, which indicated that a rupture was occurring. The ObGyn ordered oxytocin instead of performing an immediate cesarean delivery. Eleven minutes later, the cesarean was ordered, but the baby had died.

Physician's Defense: There was no negligence; proper protocols were followed. A uterine rupture cannot be predicted.

Verdict: A $650,000 settlement was reached with the hospital before trial. Because the ObGyn was employed by a federally qualified clinic, the matter was filed in federal court. The Illinois court issued a bench decision awarding $1.5 million.

Migrated IUD causes years of pain
In september 2006, an ObGyn inserted an intrauterine device (IUD) in a patient. In February 2007, the patient had an ectopic pregnancy. The IUD was not found during dilation and curettage. The patient continued to report pain to the ObGyn. She sought treatment from another physician in November 2010 due to continuing pain. A CT scan revealed that the IUD had migrated to her abdomen. The IUD was surgically removed.

Patient's Claim: The ObGyn was unwilling to figure out why the patient had continuing pain, and told her to “just deal with it.” He should have found and removed the IUD after the ectopic pregnancy.

Physician's Defense: It was reasonable to assume that the IUD had been expelled, as 2 ultrasonographies performed after ectopic pregnancy revealed nothing. Since the IUD had not caused an abscess, infection, or inflammation, the patient suffered no injury.

Verdict: A Virginia defense verdict was returned.

Profoundly disabled child dies at age 5
A 17-year-old woman with a history of miscarriage received prenatal care from her ObGyn. A July due date was established by ultrasonography in January.

In May, the mother went to the ED with pelvic pain. She was treated for preterm labor and discharged 2 days later.

In early July, ultrasonography showed a fetus in cephalic position with a posterior-located placenta.

At a prenatal examination a week later, the patient reported vaginal discharge. Her ObGyn suspected premature rupture of membranes (PROM) and admitted her to the hospital. Oxytocin was used to induce labor. Intact membranes were artificially ruptured and an internal fetal heart-rate monitor was placed. The ObGyn recorded that the pregnancy was at term.

Hours later, the mother told the nurses that she thought the fetal monitor had become disconnected; the monitor’s placement was not confirmed. The mother was given a sedative. After a few hours, she awoke with intense pain and dizziness. She used her call button, but no one immediately responded.

When full cervical dilation was reached, the fetus was at –1, 0 station. When the fetus reached +1 station, delivery was attempted. The baby was delivered using vacuum extraction.

The child’s Apgar score was 0 at 1 minute of life. Resuscitation was started with intubation and mechanical ventilation. The child’s birth weight was 6.87 lb; arterial blood gas pH measured 6.9; and gestational age was estimated at 38 to 39 weeks.

An electro-encephalogram performed in the NICU suggested intraventricular hemorrhage. The child was found to have perinatal asphyxia, hypoxic ischemic encephalopathy, left parietal skull fracture and cephalohematoma, severe metabolic acidosis, suspected sepsis, transient oliguria, and seizure episodes. The baby was hospitalized for 3.5 months and then followed regularly.

The mother and child moved from Puerto Rico to New York City to obtain better medical care. The child was regularly hospitalized until she died at age 5. 

Parent's Claim: There was a discrepancy in gestational age assessment. The nurses failed to monitor fetal heart-rate tracings at proper intervals, and they were unresponsive to the mother. Informed consent did not include vacuum extraction.

Defendants' Defense: The case was settled during trial.

Verdict: A $1.125 million Puerto Rico settlement was reached.

These cases were selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements, & Experts, with permission of the editor, Lewis Laska (www.verdictslaska.com). The information available to the editors about the cases presented here is sometimes incomplete. Moreover, the cases may or may not have merit. Nevertheless, these cases represent the types of clinical situations that typically result in litigation and are meant to illustrate nationwide variation in jury verdicts and awards.

Share your thoughts! Send your Letter to the Editor to rbarbieri@frontlinemedcom.com. Please include your name and the city and state in which you practice.

In this video, diffuse complex endometrial hyperplasia is identified using a vaginoscopic approach with a 1.9-mm diagnostic rigid hysteroscope. The posterior fornix of the vagina is filled with saline until the cervix is elevated with the fluid and the cervical os is identified. The cervical canal is entered and gentle rotational movement and hydrodistension allows the canal to be traversed into the uterine cavity. 

Video provided by Amy L. Garcia, MD

Vidyard Video

Read Dr. Garcia’s “Update on minimally invasive gynecology” (April 2015)

In this video, diffuse complex endometrial hyperplasia is identified using a vaginoscopic approach with a 1.9-mm diagnostic rigid hysteroscope. The posterior fornix of the vagina is filled with saline until the cervix is elevated with the fluid and the cervical os is identified. The cervical canal is entered and gentle rotational movement and hydrodistension allows the canal to be traversed into the uterine cavity. 

Video provided by Amy L. Garcia, MD

Vidyard Video

Read Dr. Garcia’s “Update on minimally invasive gynecology” (April 2015)

In this video, diffuse complex endometrial hyperplasia is identified using a vaginoscopic approach with a 1.9-mm diagnostic rigid hysteroscope. The posterior fornix of the vagina is filled with saline until the cervix is elevated with the fluid and the cervical os is identified. The cervical canal is entered and gentle rotational movement and hydrodistension allows the canal to be traversed into the uterine cavity. 

Video provided by Amy L. Garcia, MD

Vidyard Video

Read Dr. Garcia’s “Update on minimally invasive gynecology” (April 2015)

Use of long-acting reversible contraception (LARC) has increased nearly 5-fold in the last decade, reported the Centers for Disease Control and Prevention (CDC) in a National Center for Health Statistics (NCHS) Data Brief on the trends in LARC use among US women aged 15 to 44.¹ 

Data from the National Survey of Family Growth indicate that LARCs, which include intrauterine devices (IUDs) and subdermal hormonal implants, are gaining popularity because of their high efficacy in preventing unintended pregnancies. LARCs have demonstrated greater efficacy in preventing unintended pregnancy among all women compared with other contraceptive methods, including the oral contraceptive pill and the transdermal patch.

Age-related trends
For women aged 15 to 44, LARC use doubled between 2002 (1.5%) and the period 2006–2010 (3.8%) and then nearly doubled again for 2011–2013 (7.2%). IUD use increased 83% from the 2006–2010 period (3.5%) to the 2011–2013 period (6.4%). Implant use tripled from 2002 (0.3%) to the 2011–2013 period (0.8%).

LARC use was higher among women aged 25 to 34 than among women aged 15 to 24. The difference in LARC use was not statistically significant between women aged 25 to 34 and women aged 35 to 44.

•  LARC use increased nearly 4-fold for women aged 15 to 24 between 2002 (0.6%) and 2006–2010 (2.3%), and doubled again for 2011–2013 (5.0%).
• LARC use almost doubled among women aged 25 to 34 from 2006–2010 to 2011–2013 (5.3% to 11.1%).
• LARC use tripled between 2002 (1.1%) and 2006–2010 (3.8%) for women aged 35 to 44, and increased to 5.3% in 2011–2013.

Patterns of use by race
Although LARC use tripled for non-Hispanic white women and increased 4-fold for non-Hispanic black women between 2002 and 2006–2010, use among Hispanic women declined 10% during this period. LARC use increased by 129% among Hispanic women and by 128% among non-Hispanic white women from 2006–2010 to 2011–2013. Use of LARCs in non-Hispanic black women increased by 30% during this same period.

Parous vs nulliparous women
Women who have had at least one birth use LARC at a higher rate than women who have had no previous births. During the period 2011–2013, rate of use was 3 times greater among parous (11.0%) women compared with nulliparous (2.8%) women.

• Among parous women, LARC use increased from 2.4% in 2002 to 6.3% in 2006–2010, and to 10.6% in 2011–2013.
• In nulliparous women, LARC use increased 10-fold between 2006–2010 and 2011–2013.

For additional information, visit the NCHS Data Brief at http://www.cdc.gov/nchs/data/databriefs/db188.htm

Share your thoughts on this article! Send your Letter to the Editor to rbarbieri@frontlinemedcom.com. Please include your name and the city and state in which you practice.

Use of long-acting reversible contraception (LARC) has increased nearly 5-fold in the last decade, reported the Centers for Disease Control and Prevention (CDC) in a National Center for Health Statistics (NCHS) Data Brief on the trends in LARC use among US women aged 15 to 44.¹ 

Data from the National Survey of Family Growth indicate that LARCs, which include intrauterine devices (IUDs) and subdermal hormonal implants, are gaining popularity because of their high efficacy in preventing unintended pregnancies. LARCs have demonstrated greater efficacy in preventing unintended pregnancy among all women compared with other contraceptive methods, including the oral contraceptive pill and the transdermal patch.

Age-related trends
For women aged 15 to 44, LARC use doubled between 2002 (1.5%) and the period 2006–2010 (3.8%) and then nearly doubled again for 2011–2013 (7.2%). IUD use increased 83% from the 2006–2010 period (3.5%) to the 2011–2013 period (6.4%). Implant use tripled from 2002 (0.3%) to the 2011–2013 period (0.8%).

LARC use was higher among women aged 25 to 34 than among women aged 15 to 24. The difference in LARC use was not statistically significant between women aged 25 to 34 and women aged 35 to 44.

•  LARC use increased nearly 4-fold for women aged 15 to 24 between 2002 (0.6%) and 2006–2010 (2.3%), and doubled again for 2011–2013 (5.0%).
• LARC use almost doubled among women aged 25 to 34 from 2006–2010 to 2011–2013 (5.3% to 11.1%).
• LARC use tripled between 2002 (1.1%) and 2006–2010 (3.8%) for women aged 35 to 44, and increased to 5.3% in 2011–2013.

Patterns of use by race
Although LARC use tripled for non-Hispanic white women and increased 4-fold for non-Hispanic black women between 2002 and 2006–2010, use among Hispanic women declined 10% during this period. LARC use increased by 129% among Hispanic women and by 128% among non-Hispanic white women from 2006–2010 to 2011–2013. Use of LARCs in non-Hispanic black women increased by 30% during this same period.

Parous vs nulliparous women
Women who have had at least one birth use LARC at a higher rate than women who have had no previous births. During the period 2011–2013, rate of use was 3 times greater among parous (11.0%) women compared with nulliparous (2.8%) women.

• Among parous women, LARC use increased from 2.4% in 2002 to 6.3% in 2006–2010, and to 10.6% in 2011–2013.
• In nulliparous women, LARC use increased 10-fold between 2006–2010 and 2011–2013.

For additional information, visit the NCHS Data Brief at http://www.cdc.gov/nchs/data/databriefs/db188.htm

Share your thoughts on this article! Send your Letter to the Editor to rbarbieri@frontlinemedcom.com. Please include your name and the city and state in which you practice.

Use of long-acting reversible contraception (LARC) has increased nearly 5-fold in the last decade, reported the Centers for Disease Control and Prevention (CDC) in a National Center for Health Statistics (NCHS) Data Brief on the trends in LARC use among US women aged 15 to 44.¹ 

Data from the National Survey of Family Growth indicate that LARCs, which include intrauterine devices (IUDs) and subdermal hormonal implants, are gaining popularity because of their high efficacy in preventing unintended pregnancies. LARCs have demonstrated greater efficacy in preventing unintended pregnancy among all women compared with other contraceptive methods, including the oral contraceptive pill and the transdermal patch.

Age-related trends
For women aged 15 to 44, LARC use doubled between 2002 (1.5%) and the period 2006–2010 (3.8%) and then nearly doubled again for 2011–2013 (7.2%). IUD use increased 83% from the 2006–2010 period (3.5%) to the 2011–2013 period (6.4%). Implant use tripled from 2002 (0.3%) to the 2011–2013 period (0.8%).

LARC use was higher among women aged 25 to 34 than among women aged 15 to 24. The difference in LARC use was not statistically significant between women aged 25 to 34 and women aged 35 to 44.

•  LARC use increased nearly 4-fold for women aged 15 to 24 between 2002 (0.6%) and 2006–2010 (2.3%), and doubled again for 2011–2013 (5.0%).
• LARC use almost doubled among women aged 25 to 34 from 2006–2010 to 2011–2013 (5.3% to 11.1%).
• LARC use tripled between 2002 (1.1%) and 2006–2010 (3.8%) for women aged 35 to 44, and increased to 5.3% in 2011–2013.

Patterns of use by race
Although LARC use tripled for non-Hispanic white women and increased 4-fold for non-Hispanic black women between 2002 and 2006–2010, use among Hispanic women declined 10% during this period. LARC use increased by 129% among Hispanic women and by 128% among non-Hispanic white women from 2006–2010 to 2011–2013. Use of LARCs in non-Hispanic black women increased by 30% during this same period.

Parous vs nulliparous women
Women who have had at least one birth use LARC at a higher rate than women who have had no previous births. During the period 2011–2013, rate of use was 3 times greater among parous (11.0%) women compared with nulliparous (2.8%) women.

• Among parous women, LARC use increased from 2.4% in 2002 to 6.3% in 2006–2010, and to 10.6% in 2011–2013.
• In nulliparous women, LARC use increased 10-fold between 2006–2010 and 2011–2013.

For additional information, visit the NCHS Data Brief at http://www.cdc.gov/nchs/data/databriefs/db188.htm

Share your thoughts on this article! Send your Letter to the Editor to rbarbieri@frontlinemedcom.com. Please include your name and the city and state in which you practice.

3/24/15, Day 3 at SGS

Many topics, many learning opportunities   

The morning’s focus topics at SGS were divided up in small-group academic roundtables, with 15 experts in the field providing authoritative know-how and guidance to attendees. Topics ranged from tips for in-bag tissue extraction, endometriosis surgery, surviving health care transformation, cost-effectiveness, and single-site surgery to innovative treatments for fecal incontinence.

In the main hall, the fourth scientific session included oral presentations and videos that focused on anatomic landmarks and variations and included data presentation from an interesting prospective randomized trial in which the authors found bladder support is reduced by pregnancy, regardless of delivery method.

The highlight of the morning was certainly the debate over "power" morcellation. Dr. Cheryl Iglesia moderated in her charming and comical manner. Dr. Andrew Sokol and Dr. Jubilee Brown argued that power morcellation still should be available to a select group of appropriately chosen, low-risk women, and backed their arguments up with solid data. Dr. Eric Sokol, Andrew’s twin (and better looking, per him) brother, and Dr. Carl Zimmerman argued against the use of power morcellation, instead urging everyone in the audience to perform more vaginal hysterectomies. Though spirited and based largely on sound medical evidence, the debate did not have a clear winner. The overall consensus seemed to be that this controversial topic needed further evaluation and more data to support either claim.

"Sesame street graduates” and andragogy

We were then honored to have Vice President for Education, American College of Obstetricians and Gynecologists Dr. Sandra Carson as the esteemed TeLinde Lecturer. Her talk, “Teaching Medicine and Surgery to Sesame Street Graduates,” outlined the challenges in teaching surgery to a new generation of ObGyn residents as well as identified opportunities for improvement. She restated what seems to be the running theme at SGS this year: young faculty and residents are losing the skill for vaginal hysterectomy.

Dr. Carson introduced members of the audience to the adult theory of learning called andragogy. Adults like active learning, which is problem centered, rather than content oriented; linking new concepts to prior experience; and learning what is relevant to them, she noted. Then she shared ACOG’s strategies for applying these learning principles in resident education. She discussed ACOG’s recently formed Vaginal Hysterectomy Teaching Taskforce, which has put together a simulation consortium online toolkit and a surgical skills module to help educate residents on vaginal hysterectomy techniques. This toolkit and module can be accessed by doing a quick search after signing into the ACOG Web site.

Dr. Carson, a reproductive endocrinologist formerly at Brown University, is also now an honorary member of SGS.

Wise words from a wise physician

In his presidential address Dr. Stephen Metz acknowledged that all physicians are subject to even subtle “conflicts of interest,” reminding us to treat our patients as people not as a disease or a procedure.

“What does my patient really want from me? She wants me to get to know her to develop the right recommendations for her,” he said. His career has spanned multiple decades, and his service to the field of gynecology is outstanding. He received a well-deserved standing ovation at the end of his address.

Sport and socialization a necessity in sunny Florida!

The afternoon adjourned after the business meeting, and members were able to play golf, tennis, paddleboard in Winter Park, or just relax at the resort. Congratulations to the winners of the golf tournament (Drs. Hopkins, Rasmussen, Hurd, and Flora) and the tennis tournament (Dr. Ted Lee)!

Everyone convened at the outside terrace for the evening “Mojito Night in the Caribbean” reception, sharing good times, cocktails, and hors d’oeuvres. Proceeds from each ticket sold helped support Surgeons Helping Advance Research and Education (SHARE).

Tomorrow looks to be an excellent conclusion to a well-planned and very well-executed meeting. Kudos, and large thanks, to the SGS leadership.

3/23/15, Day 2 at SGS

Surgeons from 17 countries converge

The first day of the SGS scientific sessions was another energetic and interactive day. Sixteen new SGS members were recognized and welcomed in the main conference hall. Dr. Charles Rardin presented a brief overview and some basic statistics related to this year’s meeting—the largest ever in the history of SGS. A total of 401 attendees representing 17 countries are here in Orlando for SGS 2015! 

In the first scientific session, oral presentations touched on the subjects of preoperative dexamethasone use, vaginal packing, surgical site infections, and a new treatment modality for fecal incontinence. An excellent technique video on laparoscopic ureterolysis by Dr. Cara King then followed, in which she demonstrated excellent surgical skills with amazingly clear anatomy. Her video was recognized later in the day with a well-deserved award—congratulations! 

A short break in the exhibit hall allowed for mingling with other attendees, many of whom have been active on social media surrounding the meeting, and for visiting the booths of the industry sponsors. The second scientific session then picked up where the first left off, with more scientifically sound research presented on such topics as mechanical bowel preparation use in laparoscopy and pelvic floor disorders in women with gynecologic malignancies.

No room for fads in gyn surgery

Dr. David Grimes, a true leader in our field, provided an exceptional keynote address, “Is Teaching Evidence-Based Surgery Possible?" He shared his expertise of evidence-based medicine, and described (in sometimes very comical but always stimulating and provocative terms) the need for incorporating evidence-based surgery in gynecology. He urged us to strive to do best by our patients by applying evidenced-based practices rather than following fads and gizmos.

Gyn surgery training: Have we reached a “perfect storm”?

The afternoon brought with it a panel discussion on "Teaching the Next Generation of GYN Surgeons," with Dr. Hal Lawrence moderating and Dr. Mark Walters and Dr. Dee Fenner serving as panelists. They discussed the future of ObGyn residency training in great detail: increasing subspecialization, a stable birth rate, declining hysterectomy rates, increasing safety and quality monitoring, and increased access to data and informed consumers. All of these trends were highlighted as reasons for a perfect storm in gynecologic surgery training. In addition, the panel presented some surprising statistics: 

• The majority of hysterectomies in the United States are being done by surgeons who perform less than 1 per month.
• The higher volume surgeons provide higher value and tend to utilize more minimally invasive approaches.

Videofest!

The scientific day concluded with a videofest that included complex robotic, laparoscopic, hysteroscopic, cystoscopic, and vaginal surgeries, demonstrating the surgical talents and ingenuity of SGS members.

Simultaneously, the Fellows’ Pelvic Research Network (FPRN) met to update their ongoing projects and to review new proposals. The meeting sought to unite FPRMS and MIS fellows to conduct multicenter studies. This was an enlightening and engaging session, which should give everyone great hope to see the creativity and energy of the next generation of researchers.

A grounder for attendees

All in attendance were treated to a unique, eye-opening, motivational, and very moving talk by Professor (and Sir) Ajay Rane, MD, PhD from Australia on female genital mutilation. He stressed the importance of respecting women for who they are, not what they do.

“My idea of feminism is applauding a woman who gives birth. Celebrate women for who they are," he said. He highlighted the work being done by his team in Australia and India, and urged everyone in attendance to become more aware of the staggering statistics and reality of female genital mutilation.

The jam-packed day wrapped with the awards ceremony in the main hall. Lifelong mentors were honored by their mentees and SGS President Dr. Stephen Metz and Scientific Program Chair Dr. Charles Rardin presented various awards to those who had submitted and presented novel and groundbreaking research.

One last surprise

The President’s Reception in the exhibit hall was lively, with meeting sponsors, colleagues, and friends in attendance. And, of course, a visit from special guest! (Thanks to SGS Fellow Christina Saad, MD @XtinaSaad for the pic!)

See you all tomorrow for another educational, enlightening, and spirited day at #SGS2015! 

3/22/15. DAY 1 AT SGS

A focus on evidence-based medicine

Strong analytic skills (of your own research as well as the published literature) translates to better patient care, was the underlying theme of the opening postgraduate course here in Orlando, Florida, for day 1 of the 41st annual meeting of the Society of Gynecologic Surgeons.

Building on the success of last year’s course on evidence-based medicine (EBM), Dr. Vivian Sung and Dr. Ike Rahn put together an amazing team to review and apply the principles of so-called EBM, a workshop that was in part sponsored by ABOG.

A quick introduction to EBM principles by Dr. Thomas Wheeler was followed by small break-out groups, where attendees used the PICO-DD model to define a Population, Intervention, Comparator, Outcomes, Duration, and study Design. Further talks focused on the benefits and caveats of randomized controlled trials (RCTs), surrogate and intermediate outcomes, and systematic reviews and meta-analyses.

Dr. Ethan Balk cautioned us to consider the costly and underpowered RCT, and lack of generalizability needed to define rigorous study inclusion and outcome criteria. Dr. Sung then pointed out that, while the perfect surrogate outcome would allow us to shorten study lengths (and save money), the seduction of association and causation can lead to some questionable conclusions.

When using a clinical practice guideline, Dr. Miles Murphy indicated that a systematic review needs to be included, although a meta-analysis is not always required. The poor quality and paucity of RCTs for most patient populations is what limits us.

Dr. Rahn gave an excellent presentation on subgroup analysis, recommending to attendees that they perform these analyses cautiously, describe which groups are analyzed, and have statistical back-up for power and P value calculations.

Dr. Kristen Matteson then spoke about interpreting the literature on screening and diagnostic tests, giving a thorough but understandable review of the basics of statistics. Dr. John Wong rounded out the course, suggesting that because RCTs are expensive and comprise less than 5% of published studies, the analysis of observational studies as RCTs would allow us to better inform our patients and our colleagues on the best treatments, using patient-centered outcomes, efficacy data, and multiple providers. He urged us all to be more skeptical and ask critical questions when dealing with evidence in medicine.

Sharpening ultrasonography skills

Simultaneously, others attended a hands-on learning course on comprehensive pelvic floor ultrasonography, including transperineal, endovaginal, and endoanal imaging, organized by Dr. Abbas Shobeiri.

Tips for the difficult hysterectomy

Dr. Ted Lee (with help from Drs. Arnold P. Advincula, Rosanne Kho, and Matthew Seidhoff) prepared a surgical tutorial on laparoscopic, robotic, and vaginal strategies and techniques for approaching the difficult hysterectomy. The course was phenomenal, as described by many of the members fortunate enough to learn some of the tips and tricks demonstrated by the master surgeons.

Training for the NIH application process

Following the postgraduate courses, Dr. Katherine Hartmann led an “NIH Application Training Camp,” an offering supported by SGS research donations and a generous donation from Dr. Holly Richter. Dr. Hartmann provided in-depth insight into the world of NIH grant funding and provided background prep for a K or R award application. A mock NIH application study section, in which two actual applications were reviewed, demystified the process of grant review (and rejection). 

A social end to day 1

To end the first day, a welcome reception was held where residents, fellows, and attendings from different fields of ObGyn mingled and shared drinks, stories, and good laughs.

The "social" activities continue on social media for the rest of the conference. Follow #SGS2015, @gynsurgery, @obgmanagement, and @sukrantmehta for more!