This birth injury claim was filed in Baltimore City against Harbor Hospital and three OBs after a delayed C-section caused a baby to suffer permanent birth injuries, including cerebral palsy. It was filed in Health Claims Arbitration on March 5, 2018, and it is the 104th medical malpractice case filed in Maryland this year.Summary of Plaintiff's Allegations
A woman went to Harbor Hospital for a routine stress test (NST) while she was 31 weeks pregnant. The NST was reassuring, showing a healthy fetal heart rate and no contractions. The woman was discharged but returned to the hospital four days later complaining of pregnancy-induced hypertension. Her blood pressure, which had been normal during the NST, was elevated at 184/84.
The woman's heart rate continued to rise the next day, even after she was administered blood pressure control medication. The baby's heart rate was not continuously monitored throughout this time, but the fetal heart strips that do exist appear to be normal. After three days of an elevated maternal heart rate, the results of the fetal monitoring strip declined. The woman was administered oxygen and fluids and her doctor diagnosed her with severe preeclampsia. The only cure for this dangerous complication is to deliver the baby. The key is for the doctors and nurses to use reasonable care to best manage the problem.
Given the concerning fetal monitoring strip, the woman was sent to the fetal assessment center. The results of a biophysical profile came back normal, but two hours later, the baby's heart rate dropped dramatically for approximately eight minutes. After this prolonged deceleration, the fetal heart rate rose to a baseline of approximately 180 - a high enough heart rate to be classified as fetal tachycardia. A physician came to evaluate the woman forty minutes later. Eventually, more than six hours after the baby started showing signs of distress, the decision was made to proceed with a C-section delivery.
The baby was born bradycardic (an abnormally slow heart rate). Her APGARS were four at one minute of life and eight at five minutes of life. The placenta showed signs of a recent hemorrhage and inflammation due to a bacterial infection, most commonly associated with prolonged labor. After the baby underwent MRI and neurology evaluations, she was diagnosed with a left middle cerebral artery stroke that occurred in utero. The baby experienced seizure activity shortly after birth and she was eventually diagnosed with cerebral palsy.
The child and her family filed this lawsuit claiming that her preeclampsia was not properly managed. Specifically, they contend that the standard of care required the doctors and nurses to start magnesium sulfate at the same time they begin betamethasone and for more intensive fetal monitoring.Additional Comments
Cerebral palsy is a neurological disorder. It is a tragically common, nonprogressive, nondegenerative developmental disability that is generally characterized by abnormal muscle tone, posture, coordination, and reflexes. Cerebral palsy occurs in about 1 in 500 live births. This results in 8500 new cases of cerebral palsy annually in this country. CP can occur as the result of medical malpractice but also in the absence of malpractice.
The majority of children with CP show symptoms of cerebral palsy as infants and toddlers. The diagnosis of cerebral palsy is made before the child is 18 months and the parents typically suspect a problem long before cerebral palsy is diagnosed.
High blood pressure is often the first sign of preeclampsia, so blood pressure monitoring is an essential part of prenatal care. A blood pressure above 140/90, documented twice at least four hours apart, is abnormal. Other symptoms of preeclampsia may include excess protein in the urine, headaches, shoulder pain, blurred vision, abdominal pain, nausea, decreased blood platelets, and shortness of breath.
Other effects of preeclampsia can include renal effects, creating high protein in the urine. So that is a critical marker for the severity of the condition. There are also effects on maternal liver and liver function and the central nervous system. There can also be bleeding abnormalities. So there's a wide variety of effects that preeclampsia can have. How do you cure preeclampsia? You cannot. The only cure for it is to end the pregnancy.
Preeclampsia occurs in as many as 8 percent of pregnancies. So many preeclampsia malpractice cases are the result of obstetricians and nurses responding too causally to the symptoms of a mother or child in distress.
According to the claimant's expert witness, a maternal-fetal medicine specialist, the baby's in utero stroke caused all of her injuries and damages. If the baby had been delivered earlier, in accordance with the standards of medical care, she would have avoided the stroke and thus would have avoided brain damage.
If the fetus was in real distress six hours before delivery, this is what this case is really about. If a child is in significant fetal distress and nothing is done, that is a bigger issue that than nuances of the severity of the mother preeclampsia.
The defendants are going to claim that the preeclampsia timely diagnosed and treated and that the cause of the baby's injuries was the premature birth. There is no dispute that babies born before 37 weeks are at higher risk for cerebral palsy.
There are so many classic birth injury threads in this case. Preeclampsia, a delayed C-section, cerebral palsy, bradycardia, and a baby allegedly in distress for many hours without any action to expedite delivery are all classic birth injury lawsuit issues.
- Baltimore City
- Harbor Hospital, Inc. d/b/a MedStar Harbor Hospital
- Three obstetricians
- MedStar Harbor Hospital
Failing to obtain appropriate consultations.
Failing to react to the positive history, symptoms, signs, physical findings, and other data which indicated a predisposition for preeclampsia.
Failing to maintain and follow adequate written policies, procedures, and protocols.
Failing to timely start magnesium sulfate.
Failing to maintain continuous fetal monitoring.
Failing to appropriately evaluate and interpret the fetal monitoring strip.
Failing to diagnose and treat preeclampsia in a timely manner.
Failing to timely deliver the baby.
As a direct result of the defendants' negligence, the baby suffered a permanent brain injury, causing seizures, developmental delay, cerebral palsy, physical and mental impairment, tone abnormalities, spasticity, and neurological disabilities. The child is and will be permanently dependent upon others for her care, she will require myriad future medical procedures, and her future earning capacity has been severely diminished.
- Serdar Ural, M.D., obstetrician and maternal-fetal medicine specialist
Have you suffered a hospital injury due to the negligence of a doctor? Miller & Zois can help you. Call us at 800-553-8082 and speak to one of our medical malpractice attorneys who can help you or get an online case review.More Malpractice Claim Information
- View sample verdicts and settlements from Baltimore City.
- Read more about cerebral palsy and fetal monitoring birth injuries.
- Take a look at additional medical malpractice claims involving Harbor Hospital.
- How much is a cerebral palsy case worth?
- Another delayed C-section lawsuit filed earlier in 2018
If you are a lawyer handling preclampisa birth injury cases, you need to get to know the medical literature, these are some of the key medical journal articles:
Article undersores that preeclampsia is a pregnancy disorder characterized by hypertension that is one of the leading causes of maternal and prenatal morbidity and mortality. The problem with this condition is that traditional methods of screening, as recommended by professional guidelines, has limited predictive performance. Poon and her colleagues argue that medical professionals should use the Bayes-based method to identify pregnant women who may have PE.
“Aspirin Versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia” by Daniel L. Rolnik, M.D., et al., New England Journal of Medicine, 2017.
A study to determine whether the intake of low-dose aspirin during pregnancy can reduce the risk of preterm preeclampsia. The study involved 1776 pregnant women at high-risk for preeclampsia that were randomly assigned either a low dose of aspirin or a placebo from 11 – 14 weeks of gestation until 36 weeks gestation. An analysis was performed of results according to the intention-to-treat principle. Results found that treatment with low-dose aspirin in women at high risk for preterm preeclampsia showed a lower incidence of diagnosis than placebo. Does this mean pregnant women should all be taking asprin? No. Aspirin is not usually recommend if you are pregnancy. But low-dose aspirin is sometimes given to woman with recurrent pregnancy loss, clotting disorders and, based on this study and others like it, preeclampsia.
3. “Preeclampsia: Updates in Pathogenesis Definitions, and Guidelines” by Elizabeth Phipps, et al., Clinical Journal of American Society of Nephrology, 2016.
Preeclampsia has become an increasingly common diagnosis in the developed world and is still a leading cause of maternal and fetal morbidity and mortality in the modern world. Risk factors of the condition include maternal age, obesity, and vascular diseases – to name a few. One explanation for why preeclampsia is so prevalent is partially because of inadequate prenatal care, and in this review the most recent concepts in the pathogenesis of preeclampsia is discussed. At the very least, it is concluded that with a better understanding of the condition, researchers are optimistic for the diagnosis, treatment, and future care of the women afflicted with it.
4. “Evaluation of the clinical impact of the revised ISSHP and ACOG definitions on preeclampsia” by Anisha R. Bouter and Johannes J. Duvekot, Pregnancy Hypertension, 2019.
In 2013 and 2018, both the Society for the Study of Hypertension in Pregnancy (ISSHP) and the American College of Obstetricians and Gynecologists (ACOG) revised their definitions for the diagnosis of hypertensive disorders in pregnancy. The diagnosis of preeclampsia previously relied on the presence of hypertension and proteinuria, however the 2013 revision stated that the diagnosis of preeclampsia can be established without the presence of proteinuria when other specific symptoms are present. The change in definitions that was established in 2018 was due to the recognition of maternal and fetal risk in non-proteinuric preeclampsia, which led to increased cases of preeclampsia due to inclusion of non-proteinuric preeclampsia cases. The objective of this study was to look at the clinical impact of the use of three different new definitions for the diagnosis of preeclampsia. Results showed that more research is necessary into the course and prognosis of especially non-proteinuric preeclampsia cases.
5. “Pregnancy-Related Acute Kidney Injury in Preeclampsia: Risk Factors and Renal Outcomes” by Frances I. Conti-Ramsden, et al., Hypertension, 2019.
Preeclampsia is a common cause of acute kidney injury (AKI), however its risk factors and renal outcomes are unknown. This study of 1,547 women admitted to the hospital with preeclampsia looks at baseline demographics, admission characteristics and pregnancy, and maternal and neonatal outcomes. Women who developed acute kidney injury were more likely to die, have an eclamptic seizure, have a stroke, have received magnesium sulfate, or be admitted to intensive care compared with women who did not develop AKI during admission with preeclampsia. Principal findings showed that maternal death, exlampsia, stroke, and stillbirth rates were significantly higher in women admitted with AKI than in those without. Data suggests that AKI may be a useful surrogate marker of maternal disease severity in preeclampsia, given the high rates of intensive care admissions with increasing AKI severity.