This birth injury claim was filed in Montgomery County after health care providers allegedly ignored multiple signs that a fetus was in distress and needed to be delivered emergently. It was filed in Health Claims Arbitration on February 12, 2018, and it is the 73rd medical malpractice case filed in Maryland this year. The child suffered anoxia and this lack of oxygen allegedly has caused the boy permanent brain injuries.Summary of Plaintiff's Allegations
A woman presented to Shady Grove Adventist Hospital at 40 weeks gestation and in labor. A physician performed a vaginal examination and determined that the woman was dilated to 4 centimeters, 100% effaced, and at the -2 station. She was placed on a fetal heart monitor, which showed early decelerations and accelerations. A blood test also showed that the woman's white blood cell count was slightly elevated. Essentially, the woman and her baby were both healthy but tolerating early labor.
The doctor performed another vaginal exam, artificially rupturing the woman's membranes. The fluid was clear and odorless (indicating that the fetus was healthy) but there was only a small amount of fluid. One hour later, a nurse noticed that the fetal monitor strips were showing early and late decelerations which progressed to variable decelerations shortly thereafter.
While the doctor monitored the woman's progress over the next few hours, the nurse continued to notice variable and early decelerations on the fetal heart tracings. The nurse was concerned enough that she placed the woman on her left side, a position that is meant to increase blood flow and oxygen to the fetus. The doctor must not have realized or appreciated the seriousness of the situation because she administered Pitocin, a labor augmenting medication that can be dangerous for a fetus in distress.
The woman's contractions began occurring closer together, further weakening the fetus' supply of oxygen and nutrients. The nurse became so concerned that she placed the woman on her right side, gave her an oxygen mask, and turned off the Pitocin. The doctor remained at the bedside throughout, allowing the labor to continue.
Despite the continuous, worrisome fetal heart readings, the doctor restarted Pitocin and instructed the woman to start pushing. The fetal heart readings worsened as the woman pushed, an obvious sign that the fetus would be unable to tolerate the final hours of labor, but the doctor still went ahead with the vaginal delivery.
At birth, the baby was not breathing, showed no reflexes, and was blue in color. A head ultrasound appeared normal, but the baby's irritability and excessive crying continued until he developed seizure-like activity. After three days of life, the baby underwent a head/brain MRI and was diagnosed with anoxic encephalopathy. This means that because his brain was deprived of oxygen during delivery, the baby suffered a global loss of brain function.
The baby was transferred to Children's National Medical Center, where he remained in the Neonatal Intensive Care Unit for the next week. He has multiple medical problems, all related to the oxygen deprivation he suffered at birth.Additional Comments
When you have a nonreassuring heart rate, you should fear the baby is not getting enough oxygen. A key to this case is going to be the how these fetal heart strips look.
The Apgar score is a method for assessing a newborn's clinical status, rating the baby's skin color, heart rate, reflexes, muscle tone, and breathing on a scale from 0-10. The baby in this clam had Apgar scores of 2 at one minute of life and 6 at five minutes.
According to the claimant's expert witness, an OB/GYN, the baby could have been born healthy if he had been delivered via C-section thirty minutes earlier. The final hours of labor are often the most stressful, particularly for a fetus who was already in distress, because the fetus no longer has full access to its in-utero oxygen and nutrients supply. Thirty minutes can make a big difference for a distressed fetus who was already low on oxygen before delivery.
The expert report claims there were variable decelerations. Variable decelerations when the child's heart rate decrease is greater than or equal to 15 beats per minute and last for longer than or equal to 15 seconds but less than 2 minutes from onset to return to baseline. There is always debate about how significant the decelerations must be before the doctor acts and orders a C-section. One big thing doctors and nurses need to look for is if the baseline rate is progressively rising. That is another warning sign for hypoxia.
Another warning sign for hypoxia is late decelerations. A late deceleration is a fall in the baby's heart rate that begins at or just after the peak of the uterine contraction and then returns to baseline after the contraction. Late decelerations are not by themselves a cause for excessive alarm. But recurrent decelerations are. What is the definition of recurrent? Decelerations of any type are recurrent if they occur in 50% of the contractions over 20 minutes. A part of the reason why obstetricians are too casual about late decelerations is that so many things are incorrectly described as a late deceleration, the extent of the concern is lessened for some doctors where there is are recurrent decelerations that are a threat to the child.
Obstetricians need to remember that there is no such thing as not very severe late decelerations. All late decelerations are severe. All late decelerations are a harbinger of trouble and mean the fetus is likely suffering from hypoxia.
You will also notice that the definition of late decelerations does not mean that the fetal heart rate falls below the baseline rate. But the failure to fall below the baseline rate should not change the urgency
The lawsuit does not name the nurses as defendants but does blame them for their negligence conduct. Nurses have a lot of responsibility when it comes to administering Pitocin. This drug is frequently used in labor but it can really make a bad problem worse when the administration of the drug is not discontinued when the baby has a nonreassuring heart rate. Every OB/GYN expert will agree that uterine hyperstimulation is not indicated when there are persistent variable or late decelerations.
- Montgomery County
- Two Bethesda OB/GYNs
- Adventist Healthcare, Inc. d/b/a Shady Grove Adventist Hospital
- Capitol Women's Care, LLC d/b/a Capitol Women's Care
- Shady Grove Adventist Hospital
- Children's National Medical Center.
Failing to recognize the baby's worsening condition.
Failing to appropriately respond to the mother's and the baby's condition.
Failing to properly manage and monitor labor and delivery.
Failing to recognize and respond to the ominous signs of fetal distress over a prolonged period of time.
Failing to appreciate the danger of administering Pitocin in the face of concerning fetal heart and contraction patterns.
Failing to perform a timely C-section.
Failing to timely resuscitate the baby when he was born and have trained pediatric personnel ready at the bedside.
Failing to communicate among the medical staff or with the patients.
As a direct result of the defendants' negligence, the baby suffered permanent brain damage and neurological impairment, including cerebral palsy, hypoxic ischemic encephalopathy, and neonatal seizure disorder.
- Kenneth Naylor, M.D., Obstetrics and Gynecology
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