Was cesarean indicated for dystocia?
<court>San Bernardino County (Calif) Superior Court</court>
When an obese woman with gestational diabetes presented to a hospital, fetal heart-rate tracings for her unborn child were nonreassuring.
The resident physician ruptured the membranes in an effort to hasten delivery, at which time the woman’s cord prolapsed outside her uterus. The resident opted to replace the cord rather than attempt cesarean delivery.
Two hours later, fetal monitoring indicated the infant was in distress; still, the labor was allowed to continue. The attending physician was called in to perform a vaginal delivery 3 hours later, at which time shoulder dystocia with cord compression was encountered.
The child was born with hypoxic ischemic injury. Six years old at the time of trial, she suffers from mental retardation and will require custodial care for life.
In suing, the mother claimed her risk factors for dystocia—obesity, gestational diabetes, and a 60-pound weight gain during pregnancy—should have prompted doctors to perform an ultrasound and fetal size assessment upon admission. This, she claimed, would have pointed to the need for cesarean. She further maintained that both the cord prolapse and the signs of fetal distress were indications for immediate cesarean delivery.
The defense noted that the pH levels taken shortly after birth were not consistent with severe hypoxia in the perinatal period; further, magnetic resonance imaging did not show any evidence of significant brain injury. They also argued that any neurologic injury that did exist may have occurred prior to the mother’s admission.
- The plaintiffs settled for $2 million against the defendant medical center, provided both defendant physicians were dismissed.
The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.