Did prolapsed cord cause injuries?
<court>Honolulu County (Hawaii) Circuit Court</court>
A pregnant woman who was under care of her family practitioner, who had provided her prenatal care, was admitted to a hospital for childbirth. The membranes were artificially ruptured and within 1 to 2 minutes the fetal heart strip showed a prolonged deceleration from a baseline of 150 bpm to 60 bpm, lasting 4.5 minutes.
The physician conducted a vaginal examination at the time of this deceleration and discovered a loop of cord along the left side of the infant’s head, which was described in the records as a prolapsed umbilical cord. He manually elevated the infant’s head, reducing the cord. He then instructed the mother to push, allowing labor for a half hour. During this time several instances of fetal distress were noted, with the fetal heart rate ranging from 60 to 120 bpm.
At some point the physician attempted to call the primary and back-up obstetricians on-call, but the primary was busy with a procedure at another hospital and the back-up OB was 45 minutes away.
The infant, born with the umbilical cord along the left side of the head, had severe brain damage due to profound anoxia. He also had a fractured right humerus and a small subdural bleed with a corresponding intracerebral contusion. He has limited cognition, is fed through a PEG tube, has a tracheostomy, and requires 24-hour care in a nursing home.
In suing, the woman asserted that a cesarean section should have been performed when the prolapsed cord was diagnosed and that the hospital’s policy regarding the on-call obstetrician was inadequate, as it allowed both of the obstetricians to be unavailable.
The physician contended that he did not diagnose a prolapsed cord prior to delivery but that the records were written later and were not a comment on what he knew at the time of delivery. The hospital claimed that its on-call policy was appropriate for a community hospital. Both the hospital and the physician contended that the child’s injuries were not due to anoxia from a prolapsed umbilical cord.
- A $10.95 million settlement was reached.
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.