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Alleged Sexual Assault

Birth Injury - Causation

  • Evaluating neurologic injury: birth injury vs. antepartum vs. postpartum causation
  • Looking for birth injury “look alikes”: endocrine and metabolic diseases, birth defects, neonatal injury

Cervical Leep Complications
Cesarean Section Complications

  • Bowel injury: occurrence, failure to diagnose
  • Cellulitis
  • Cesarean Hysterectomy: indications, performance, sequelae
  • Wound infections

Domestic Violence During Pregnancy

Drugs and Birth Defects

  • SSRI’s (Paxil, Effecxor, Celexa) and cardiothoracic fetal defects
  • Methotrexate inadvertently administered to intrauterine pregnancies

Ectopic Pregnancy

  • Timely diagnosis and treatment
  • Future fertility potential assessment
Domestic Violence During Pregnancy

Endometriosis

  • Diagnosis, timely vs. delayed; clinical “look alikes” e.g., pelvic adhesions
  • Medical and surgical treatments
  • Recurrence risks
  • “Definitive treatment” – hysterectomy; type of hysterectomy, associated complications
  • Indication for ovary removal at hysterectomy

Electronic Fetal Monitor (EFM)

Essure: Transcervical Tubal Sterilization

  • Patient selection
  • Performance of procedure
  • Post-procedure assessment and patient follow-up
  • Epidemiologic analysis of literature in evolution

Family Law Consultations

  • Epidemiology of genital Herpes infections
  • Epidemiology of Human Papilloma (HPV) colonization vs. infection
  • Alleged sexual assault – adult and pediatric
  • Transgender issues and child custody

Fetal Laceration at Cesarean Section

Foreign Bodies

  • Vaginal foreign bodies associated with D&C, hysteroscopy, laparoscopic procedures
  • Intra-abdominal foreign bodies associated with hysterectomy, laparoscopy, laparotomy

Hypoxic Ischemic Encephalopathy

Hysterectomy Complications

  • Thromboprophylaxis, chemical vs. sequential compression devices (SCD’s)
  • Inadvertent suture placed in bladder wall: recognition, treatment, possible sequelae
  • Distal ureteric obstruction: suspicion, diagnosis, sequelae
  • Bowel injury: suspicion, diagnosis, sequelae
  • Positioning injury with stirrups: boot type vs. stirrup type
  • Vesicovaginal fistula following hysterectomy
  • Uterine sarcoma: discovered at hysterectomy vs. delayed diagnosis

Iatrogenic Injury from Cosmetic Procedures

  • Vulvar 1st/2nd degree burns from genital laser hair removal
Hypoxic Ischemic Encephalopathy

Incarcerated Pregnant Women

  • Standard care in pregnancy, including high risk pregnancies
  • Opioid abuse disorder in incarcerated pregnant women

Infertility Including In Vitro Fertilization (IVF)

  • Indications for medications, laparoscopy/hysteroscopy, IVF
  • Thrombosis risk with fertility drugs and IVF
  • Use of donor eggs, use of donor sperm

Insurance Reviews

  • Fetal surgery: experimental vs. standard of care
  • Various medical conditions: timeliness of diagnosis, treatment or referral
  • Causation analysis within complex cases

Management of Ovaries at Hysterectomy

Medication Complications

  • Topical anesthetics with vs. without epinephrine
  • Oral contraceptives, Depo-medroxyprogesterone
  • Fetal effects with inadvertent use, e.g., methotrexate
  • Sedation effects with drug combinations
  • Thrombotic effects of progestins, GnRHa’s, oral contraceptives

Menopause

  • Peri- vs. post-menopausal bleeding: evaluation techniques, treatment options
  • Medical treatments vs. surgical treatments
  • Menopausal medications and breast cancer
  • Conjugated equine estrogens as an unusual cause of pancreatitis

Methotrexate, Inadvertent Use

  • Over-reliance of a single HCG level
  • Misdiagnosis of early intrauterine pregnancy as ectopic pregnancy
Management of Ovaries at Hysterectomy

Motor Vehicle Accidents and Pregnancy

  • Nonreassuring fetal heart monitoring
  • Preterm labor and delivery
  • Neonatal positional problems, e.g., torticollis
  • Temporal association with loss of chemical pregnancy
  • Causation of vs. temporal association with, miscarriage in the first trimester
  • Association vs. causation of placental abruption in later pregnancy
  • Association vs. causation of stillbirth in third trimester

Multiple Pregnancies

  • Diagnosis by early ultrasound; sonographic follow-up
  • Determining monoamniotic or monochorionic twins
  • Special aspects of preterm labor and preterm delivery
  • Special aspects of cervical incompetence, bed rest, tocolysis

Military Medicine, OB/GYN Matters in the Context of

  • Ectopic pregnancy, diagnosis and treatment
  • Obstetric care
  • Gynecologic surgery

Miscarriage

  • Indication/timing of cervical dilation/uterine curettage (D&C)
  • Repeated pregnancy loss: evaluation, diagnosis, treatment and prognosis
  • Association vs. causation: first vs. second and third trimester motor vehicle accidents

Neonatal Encephalopathy - Avoidance, timely delivery

Office Procedures

  • Sonohysterography: uses and pitfalls
  • Office hysteroscopy
  • Endometrial ablation: proper patient selection, proper performance
  • ESSURE sterilization: patient selection, proper performance, post-procedure follow-up
  • Endometrial biopsy
  • Use of lidocaine with or without epinephrine: dose calculation, complications

Pap Smears

  • Excessively aggressive treatment: cervical incompetence, dyspareunia, infertility
  • Biopsies: colposcopy and loop electrical excision procedure (LEEP)
  • Fertility aspects/reproductive potential

Female Pelvic Fracture

  • Reproductive potential
  • Genital injury associated with bony fracture

Chronic Pelvic Pain

  • Interstitial cystitis and its “look-alikes”
  • Endometriosis: diagnosis, treatment, reducing recurrence
  • Pelvic infections
  • Pelvic adhesions (“Pelvic Adhesive Disease”)
  • Treatments, including chiropractic and Botox injections
  • Prognosis

Placenta

  • Retained placenta, complications thereof, at vaginal and Cesarean delivery
  • Placenta previa
  • Placenta abruption (Placenta abruptio; premature separation of the placenta)
  • Placenta accreta
  • Placental anomalies (Circumvallate, succenturiate, bilobed, et al.)
  • Twin-to-Twin Transfusion Syndrome (TTTS)
  • Meconium staining
  • Placental infarctions
  • Clinical interpretation/application of placental pathologic findings

Polycystic Ovaries Syndrome (PCOS)

  • Metabolic Complications
  • Insulin Resistance
  • Fertility Complications

Pre-Eclampsia, Postpartum

Pregnancy Induced Hypertension (Toxemia, Pre-Eclampsia)

  • Diagnosis, and delay/lack thereof
  • HELLP (Hemolysis, Elevated Liver function tests, Low Platelets) Syndrome
  • Thrombocytopenia (low platelet count)
  • Distinguished from gestational hypertension or chronic hypertension

Pregnancy Complications

  • Decreased fetal movement: diagnosis and evaluation
  • Hyperemesis gravidarum: diagnosis, differential diagnosis within, treatment, follow-up
  • Indications for induction of labor; choice of induction agents
  • Stillbirth, intrauterine fetal demise (IUFD): diagnosis, evaluation, prognosis
  • Adrenal disease in pregnancy: adrenal tumors, Addison’s disease
  • Cholestasis of pregnancy: diagnosis and treatment
Pre-Eclampsia, Postpartum

Preterm Labor (PTL) and Delivery Risks

  • Cervical incompetence: pro’s/con’s of historical vs. objective diagnosis
  • Transvaginal assessments of preterm labor risk (fetal fibronectin)
  • Ultrasonographic measurement of cervical length
  • Recognizing symptoms/signs of PTL by physicians, nurses, and other staff
  • Factors potentially impacting PTL risk: cervical lacerations, vaginal/cervical infections, stress

Premature Rupture of Membranes (PROM)

  • Assessment and diagnosis; false positives and negatives of diagnostic tools
  • Ultrasonographic assessment of amniotic fluid

Retained Foreign Bodies at Surgery Including Cesarean

Sexual Assault

  • Presence, or absence, of genital injuries following alleged sexual assault
  • Evaluating evidence for consensual contact vs. sexual assault
  • Presence, or absence, of anal injuries following alleged assault

Sexual Assault, Prosecution and Defense

  • Evaluating SANE nurse reports
  • Evaluating consensual vs non-consensual injuries
Retained Foreign Bodies at Surgery Including Cesarean

Toxic Torts: Water contaminated with heavy metals causing miscarriage

Transport of the Pregnant Woman

  • Choice of hospital by ambulance staff
  • Second motor vehicle collision involving pregnant woman during ambulance transport

Transvaginal Ultrasound

Trauma as Possible Cause of Miscarriage: Car accidents, fights

Unnecessary/Unindicated Hysterectomy

Vaginal Mesh in Gynecologic Surgery

  • Indications, alternatives in terms of techniques and materials
  • Epidemiologic analysis of evolving medical literature

Voluntary Termination of Pregnancy (VTP), Abortion

  • Retained tissue at attempted VTP
  • Ongoing pregnancy despite attempted VTP
  • Complications of VTP procedures and medications

Vulvar and Vaginal Disease

  • Complications of laser hair removal
  • Bartholin’s gland cyst and abscess treatment and complications
  • Surgical complications: removal of excess labial tissue
Unnecessary/Unindicated Hysterectomy

Vulvar and Vaginal Disease

  • Complications of laser hair removal
  • Bartholin’s gland cyst and abscess treatment and complications
  • Surgical complications: removal of excess labial tissue

Weight Loss Clinics

  • Employee delegation and supervision issues
  • Misrepresentation of care provided, with subsequent patient reliance thereof
  • Substandard care and follow-up resulting in Medical Board involvement

Wound Complications

  • Cellulites, fascial infection, abscess: diagnose, treatment and sequelae
  • Wound separation and dehiscence

Dr. Jim Wheeler is a medicolegal consultant who provides expert reviews of clinical data and published research in support of legal presentations. Educated in Boston, New Haven, and Houston, he has reviewed cases in the U.S., Canada, the U.K., Australia, New Zealand, Peru, and Barbados. Dr. Wheeler is available to serve all venues and jurisdictions as needed.