In a lawsuit against an obstetrician for 1 billion won ($769,053) in damages after a mother died from postpartum hemorrhage, the court has ruled that the doctor was not liable.

The Seoul Northern District Court recently dismissed all damage claims filed against the obstetrician by the family of a patient who died after giving birth.

The deceased patient gave birth at a women's hospital in August 2018. The direct cause of her death was postpartum hemorrhage due to disseminated intravascular coagulation. The bereaved family claimed that the obstetrician in charge of the patient was negligent in her care.

The bereaved family claimed that the obstetrician-gynecologist in charge of the patient breached his duty of care and caused the patient's death. They demanded compensation totaling 1,051,014,665 won plus delayed interest. The family said the doctor was negligent in administering excessive uterine contractile drugs, causing uterine rupture, failing to treat lacerations properly, and performing the Bakri procedure while bleeding continued, adding that he also neglected to observe the progress or transfer the patient.

However, the tribunal did not accept all of these claims.

"The three uterotonics administered to the patient -- Oxytocin, Methergine, and Duratocin -- were not outside the scope of customary practice," said the two medical examiners who reviewed the case.

In theory, Duratocin could be associated with uterine rupture, but there have been no cases of uterine rupture caused or exacerbated by uterotonics administered to stop postpartum bleeding, they said.

The plaintiff’s allegations that the doctor did not properly diagnose and treat the patient’s cervical laceration and that the Bakri procedure enlarged the laceration and caused her uterine rupture were also not sufficiently proven to link the cervical laceration to the uterine rupture, the court also judged.

"At the time of the bleeding, the patient's pulse was in the normal range, and her blood pressure was not significantly different from the time of delivery. There were no other symptoms, such as cyanosis due to blood loss, and her state of consciousness was clear. Under these circumstances, one cannot believe the doctor should have suspected massive bleeding from a cervical laceration and immediately checked and sutured it,” the court said. “As the doctor sutured the laceration and arrested hemorrhage, and there was no evidence of bleeding immediately after the Bakri procedure, the diagnosis, and treatment were not wrong.”

It is very rare for a uterine rupture to occur during a Bakri procedure immediately after childbirth, and the patient's vital signs recovered after the procedure, so it cannot be concluded that the procedure itself was wrong or caused the patient's death, the tribunal said. Even if the uterus ruptured during the Bakri procedure, it is difficult to see how the doctor could have diagnosed it or should have anticipated it, it added.

The court ruled that post-procedure follow-up was adequate, and the choice of a different hospital rather than a closer one "cannot be considered a breach of the duty of care as it was a decision based on many circumstances." The fact that the doctor who accompanied the patient throughout the procedure only provided ambush bagging for the patient, who developed acute respiratory distress shortly before arrival, was also deemed acceptable based on the assessment.

The tribunal also rejected the claim that the doctor breached his duty of care by not fully explaining the risk of side effects to the patient before the Bakri procedure.

“Even if the doctor did not explain the possibility of uterine rupture from the Bakri procedure, it could not be concluded that the Bakri procedure caused the uterus to rupture," the tribunal said. “And even if the rupture occurred during the operation, it is difficult to see that the physician had a duty to foresee and explain it."

The court also said that the fact that the duty of explanation was breached was not enough to require alimony. The cases in which doctors are obligated to pay alimony are limited to invasive medical procedures, such as surgery, or acts that have a foreseeable serious consequence, including death.

Accordingly, the court dismissed all the claims for damages as being without merit and ordered the bereaved family to bear the costs of the lawsuit.