$2 million for baby’s injuries in prolonged delivery

2008 Trial Lawyers Report

Medical malpractice settlement: Failure to deliver child in the presence of non-reassuring findings results in neurological injury to child

In 1998, the minor plaintiff’s mother was a 30-year old woman expecting her first child on May 2, 1998 (by dates). Her pregnancy was uneventful.

On April 29, 1998, the minor plaintiff’s mother went into labor at approximately 7:00 am. At 1:00 pm. she spontaneously ruptured her membranes and went by ambulance to Mount Auburn Hospital. On arrival, her cervix was fully dilated with the fetal head at +2 station.

The external fetal monitor was applied at 2:47 pm and showed a baseline rate in the 140s with good variability. At around 3:15 pm, a series of fetal heart rate decelerations appeared and persisted throughout labor. At 3:35 pm, the nurse defendant noted that the fetal heart rate decreased to the 90’s. By 3:40 pm, there were diminished variability, recurrent decelerations and tachycardia—non-reassuring signs of fetal intolerance to a hostile uterine environment. There is no indication that the nurse defendant notified the covering obstetrician about the non-reassuring tracing. The minor plaintiff’s mother was urged to push and at the same time the defendant nurse instituted intrauterine resuscitative measures by placing her on her left side and by starting an infusion of Lactated Ringers. These measures are generally undertaken in response to a non-reassuring pattern in order to improve the oxygen supply to the baby.

At approximately 4:30 pm, the nurse indicated that the baseline fetal heart rate was between 90 and 150. Plaintiff’s expert was prepared to opine that the monitor, in fact, showed late decelerations and variable decelerations with late components. There is no indication in the medical records that these non-reassuring findings were reported to the covering physician.

At 5:45 pm, the defendant obstetrician was in the room and advised the minor plaintiff’s mother to allow spinal anesthesia and vacuum or forceps delivery because of what was being seen on the monitor. By that time she had been pushing for nearly three hours, however, the plaintiff’s mother was fearful of forceps and did not want them used. During this conversation with the plaintiff’s mother, the defendant obstetrician decided to allow her to push for another 45 minutes before making a decision, despite what was being seen on the fetal heart monitor.

At 7:29 pm, the defendant obstetrician returned and delivered the baby using both vacuum and forceps. He noted that after four and a half hours of complete dilation the mother had consented to delivery by vacuum and forceps. The defendant physician noted that it took three attempts with the vacuum to bring the baby’s head to the perineum, that a right mediolateral episiotomy was done, and that low forceps were then applied to the head.

The minor plaintiff had Apgar scores of 5/8. Meconium was present at delivery. He was hypotonic at birth with marked molding of the head and marked swelling in the left parietal occipital area. The plaintiff’s expert was prepared to testify that these are findings consistent with a prolonged second stage of labor and misuse of the vacuum and forceps. The baby required resuscitation in the delivery room and during his newborn course, he developed seizures. On April 30, 1998, he was transferred to a Boston hospital with a question of hypoxia secondary to a prolonged second stage of labor.

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An April 30, 1998 CT scan indicated the presence of a small left frontal hematoma over the right occipital and left frontal regions with an associated small subdural hematoma over the left frontal region. The minor plaintiff developed additional seizure activity on day one and two of life and received multiple anti-convulsant medications. He developed necrotizing enterocolitis on day three of life, most likely from his hypoxic insult, and a colectomy was performed with insertion of a G-tube and creation of an ileostomy. He was intubated on May 3, 1998 for shock and increased work of breathing. He remained intubated until May 19, 1998. He was discharged from hospital on June 12, 1998.

Currently, the minor plaintiff has developmental delays and is enrolled in Special Education classes in the public school system, with occupational and speech therapy. He is also still followed for his seizure disorder with medications.

During the course of litigation, the defendants alleged that they appropriately used the vacuum and forceps and that there was no injury to the fetal brain during this assisted delivery. They were further prepared to testify that their decision to allow additional time for the mother to labor was appropriate and that the changes seen on the brain imaging studies were not caused by any delay in delivering the child. Trial was scheduled for December 2008 and the case settled prior to that time.

Attorneys from Lubin & Meyer representd the plaintiff in this birth injury lawsuit.

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