Uterine Rupture Resulting in Stillbirth

The Mapel Case

In this case, we represented Michael and Dawn Mapel, who brought suit on behalf of the Estate of their daughter, Andrea Rose Mapel. Tragically, Andrea Rose Mapel was born stillborn at St. Clair Memorial Hospital on April 12, 2003.

Mrs. Mapel, a vaginal birth after C-section (“VBAC”) patient, was admitted in labor to St. Clair Memorial Hospital at 4:40 am on April 12, 2003. Deborah Ann Lenart, M.D. was Mrs. Mapel’s obstetrician.

When attempting a VBAC, because the scar from the prior C-section may tear open, VBAC patients are at an extremely high risk for a uterine rupture. Once a uterine rupture is suspected, an emergency C-section must be ordered immediately or the baby can become brain damaged or die. Therefore, the standard of care requires that the health care providers have a heightened sense of suspicion and be on the lookout for the first sign or symptom of a uterine rupture. The classic signs and symptoms of a uterine rupture include tachycardia, hypotension, nausea and committing, abdominal pain, fetal stress (non reassuring late decelerations), and bleeding (external or internal).

Throughout the late morning and into the afternoon, Mrs. Mapel demonstrated all of the classic signs of uterine rupture. Mrs. Mapel had numerous episodes of hypotension, was nauseous, vomited three times, had abdominal pain, had multiple non reassuring late decelerations on the monitor, and exhibited signs of internal bleeding. In response to these ominous signs and symptoms, Dr. Lenart and the obstetrical nurses merely treated them instead of looking for the actual cause and/or reasoned that the signs were a result of anything other than a uterine rupture (Mrs. Mapel was given ephedrine for her hypotension, an epidural for the abdominal pain. Dr. Lenart and the obstetrical nurses assumed the nausea was from the epidural, that the vomiting was normal labor vomiting, and testified that there weren’t enough non reassuring late decelerations).

After Dr. Lenart finally placed an internal fetal scalp electrode at 2:22 pm, she realized that the external fetal monitor had been picking up the mother’s heart rate. The fetal scalp electrode revealed that the baby’s heart rate was below 60 beats per minute. Now realizing the medical emergency, Dr. Lenart ordered a stat C-section. Mrs. Mapel was taken back to the operating room and a C-section was performed; unfortunately, it was too late – Andrea Rose was stillborn at 2:37 pm.

Suit was brought against Dr. Lenart and St. Clair Memorial Hospital (obstetrical nurses). After three years of litigation, the case proceeded to a jury trial. At trial, the Plaintiffs’ expert obstetrician opined that the Defendants clearly breached the standard of care by failing to appreciate the classic signs and symptoms of a uterine rupture and by failing to order a timely C-section. The expert further opined that the Defendant’ deviations resulted in the stillbirth of Andrea Rose Mapel. The Defendants’ expert obstetrician, Dr. Richard Depp, opined that the signs and symptoms, which Mrs. Mapel exhibited for hours, were non-specific and obscured by the ephedrine and the epidural.

After a six-day jury trial, the jury returned a verdict in favor of the Mapels and against Dr. Lenart in the amount of $895,000.00. After delay damages in the amount of $152,592.17 were added, the total verdict was molded to $1,047,592.17.

Following trial, Dr. Lenart filed various post-trial motions requesting the Trial Judge to strike the verdict and grant a new trial. After we successfully opposed these motions, Dr. Lenart appealed the case to the Pennsylvania Superior Court based on numerous allegations that the Trial Judge committed reversible error when ruling on various evidentiary issues. After both sides submitted lengthy appellate briefs, Harry Cohen successfully argued the case before a panel of Superior Court Judges who issued an Opinion affirming the Trial Court and upholding the verdict.

After Dr. Lenart was unsuccessful in having the appeal heard a second time before a different panel of Superior Court Judges, she then attempted to appeal the case to the Supreme Court of Pennsylvania; however, the Pa. Supreme Court declined to hear the case, thus ending the appeal process. In all, the appeal process took close to 3-years to conclude. During this time, post-judgment interest, calculated at 6% annually, continued to accrue on the verdict which brought the total judgment amount to $1,238,725.88 which was fully collected.