Was earlier cesarean indicated?
<court>Undisclosed Massachusetts venue</court>
Ultrasound examination of a woman at 16.4 weeks’ gestation revealed anterior marginal placenta previa. Three months later, follow-up study showed the condition had resolved, with the placenta in an anterior position.
At 33 weeks, the woman suffered a fall, but did not sustain abdominal trauma. At 35 weeks, she was involved in a motor vehicle accident, but maintained normal fetal movement. At 38 weeks she was treated for suspected urinary tract infection after reporting decreased fetal movement. At 40 weeks, following a normal reactive stress test and observation of a normal, active, vertex fetus, the physician scheduled an induction for 8 days later.
The next day, the plaintiff reported contractions every 5 minutes and decreased fetal movement. At the hospital, no cervical dilation was observed. The fetal heart rate was 140 with accelerations to 150 to 160 and average long-term variability.
She was discharged home, but returned in labor the following day, with a cervical dilation of 6 cm and bulging membranes. The fetal heart rate on arrival was in the 150s; 15 minutes later, decelerations to 90 were noted, with poor beat-to-beat variability. Vaginal examination 10 minutes later revealed meconium with spontaneous rupture of membranes.
An hour later, the fetal heart rate fell to 100, with decelerations to 50 to 60. The child was delivered by emergency cesarean section 17 minutes later. Apgar scores were 0, 0, and 3, and cord pH was 6.86. The child was transferred to another facility and suffered seizures within 12 hours of birth. It was determined that the child suffered perinatal hypoxic ischemic encephalopathy.
The plaintiff sued, arguing that cesarean should have been performed earlier.
The defendants denied negligence, noting normal tests the day prior to birth, and maintaining that the fetal heart rate during labor was not diagnostic of fetal distress.
- The case settled for $400,000 at mediation.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (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.