Bradycardia is the medical term for an abnormally slow heart rate. Abnormality in a baby's heart rate during pregnancy or delivery is referred to as fetal arrhythmia. Bradycardia is a slow heart rate and tachycardia is an excessively high heart rate. During pregnancy and delivery, bradycardia is often a critical initial warning sign that the baby is under duress. Fetal bradycardia is occurs when the baby's heart rate is drops below 110 for longer than 10 minutes or 100 for 5 minutes. Normal fetal heartrate is generally between 120 and 160 beats per minute. There are several distinct types of fetal bradycardia: (1) sinus bradycardia; (2) atrial ectopic block; and atrioventricular (AV) block. Fetal bradycardia can be particularly concerning because if the baby's heart is beating too slow they may not be getting enough oxygen or blood to the brain.
The initial diagnosis of fetal bradycardia occurs with electronic fetal monitoring (EFM) devices. Monitoring of the baby's heart rate is an important part of labor and delivery. This is usually done externally with a device known as a fetal monitoring strip. This is a belt that is strapped across the mother's stomach and it electronically records the baby's heart rate.
A fetal echocardiogram is utilized to make a more in-depth diagnosis of fetal bradycardia. The echocardiogram enables doctors to analyze the conduction patterns and identify what particular type of bradycardia is occurring.
Fetal bradycardia can be caused by any event or delivery complication that puts the baby under physical stress and/or restrict the flow of oxygen to the baby. Complications that can potentially cause bradycardia include: umbilical cord prolapse, placental abruption, and uterine rupture. Various types of narcotics in the mother's system can cause fetal bradycardia. Fetal bradycardia can also result from epidural drugs administered before labor or from synthetic hormones like oxytocin which are used to facilitate delivery. Maternal hypotension (low blood pressure) can also cause fetal bradycardia. Compression or twisting of the umbilical cord and other complications during delivery can also cause or lease to bradycardia.
Detecting fetal bradycardia and taking the appropriate action can be very important to the health of the baby. The appropriate management or treatment will vary depending on what stage of pregnancy or delivery the bradycardia occurs. When fetal bradycardia occurs early during pregnancy, the appropriate treatment and management will vary greatly depending on what type of bradycardia is present. Fluorinated steroids, immunoglobulin and beta-sympathomimetic drugs are used in various cases to treat certain types of bradycardia during early pregnancy. When fetal bradycardia occurs later in pregnancy or during labor, it may require an emergency C-section delivery.
What level of bradycardia rises to the level of concern that the baby is in distress? This question is litigated in birth injury lawsuits every year. Generally, a bradycardia more than a minute is of some concern. You start looking at other possible signs of distress. But certainly, a minute long bradycardia is not grounds for panic. But bradycardias that last ten minutes is a major concern.
The other problem with fetal bradycardia is that it is not just a warning sign but a cause of hypoxic-ischemic encephalopathy because it depletes some the oxygen reserves the child has.Bradycardia and Fetal Monitoring Malpractice
Doctors and hospitals have an obligation to properly monitor for bradycardia and other signs of fetal distress. When fetal distress occurs they are also required to exercise the appropriate skill and care in responding to the situation. Malpractice claims involving bradycardia are either based on failure to properly monitor or negligence in responding. No one is arguing that bradycardia equals fetal distress. But a thread running through so many birth injury lawsuits is a child is having significant bradycardia and other symptoms of a fetus in distress and the doctors and nurse failing to act to deal with the possibility that the fetus is suffering from hypoxia.Sample Verdicts & Settlements
Below is a summary of verdicts and reported settlements in malpractice cases involving fetal bradycardia. These summaries are for informational purposes only.
- Plaintiffs v HMO (California 2017) $2.1 million: Plaintiffs alleged that doctors and hospital were negligent because they failed to perform an emergency c-section delivery promptly after severe fetal bradycardia was identified during labor. Plaintiff's claim that the 2-hour delay between the bradycardia and the eventual C-section delivery resulted in hypoxic-ischemic encephalopathy and other birth injuries. The case was settled prior to trial for $2.1 million.
- Martinez v Turner (New Jersey 2016) $1 million: The doctor was accused of negligently responding to sudden fetal bradycardia. When the baby's heart rate suddenly dropped, the doctor performed a vacuum-assisted delivery. However, the delivery was further complicated by shoulder dystocia. In his rush to deliver in response to the bradycardia the doctor apparently failed to use appropriate skill and care in overcoming the shoulder dystocia. Excessive downward traction allegedly caused a severe brachial plexus injury resulting in significant paralysis of the right arm. The doctor refused consent for his insurance company to settle until the conclusion of the trial at which time the case settled for policy limits of $1,000,000.
- Torres v Scott (New Jersey 2010) $1.1 million: This is another delayed C-section bradycardia case. Approximately 8 hours into labor at the hospital, the baby suddenly experienced severe bradycardia. Instead of immediately performing an emergency c-section, the delivery team attempted an unsuccessful vacuum extraction. The fetal bradycardia got even worse at which point an emergency C-section was performed. The baby was born in a vegetative state with severe brain damage and died a few days later. The hospital and nurse defendants settled prior to trial for $275,000. At the conclusion of the trial, the doctor defendant settled for $900,000.
- Altamimi v Kaiser Foundation Hosp (California 2009) $3.5 million: This case involved claims of negligent failure to monitor for bradycardia. A few hours into labor, the doctors and nurse left the mother unattended in the delivery room for an extended time. There was a remote monitor at the nurse station, but that was also vacant. The nurse returned to find the fetal hear monitor warning of severe bradycardia. An emergency c-section was immediately performed but the baby suffered hypoxic-ischemic encephalopathy. The case was submitted to arbitration and the arbitration panel awarded $3.5 million.
If your child was born with birth injuries that may have resulted from a failure to monitor or respond to bradycardia or other signs of fetal distress, the birth injury lawyers at Miller & Zois can help. We can gather your medical records and work with medical experts to investigate your case. You may be able to get financial compensation if a mistake was made. Call our birth injury malpractice lawyers at 800-553-8082 or get a free online consultation.Additional Information on Birth Injury Malpractice
- This 2018 lawsuit involved allegations that the doctors failed to respond to the child's bradycardia, among other symptoms
- Birth Injury Malpractice
- Shoulder dystocia
- Placental abruption
- Herpes encephalitis
- Caput Succedaneum
- Intrauterine growth restriction
- Perinatal Encephalopathy
- Uterine rupture
- Placenta previa
- Hypoglycemia-induced brain injury
- Brain Bleeding
- Meconium Aspiration Syndrome
- Fetal macrosomia
- Periventricular Leukomalacia
- Neonatal stroke