Fetal Monitoring Malpractice Frequently Asked Questions

cerebral palsy Maryland Most birth injury medical malpractice lawsuits involve interpretation of fetal monitoring strips. The most common obstetrical procedure is electronic fetal monitoring (EFM) during labor. Monitoring is typically accomplished externally by wrapping a belt with sensors around the mother's belly. Alternatively, EFM can be done by attaching an electrode to fetus. The monitor produces a continuous paper strip that tracks the baby's heart beat on the top and the pattern of the mother's uterine contractions along the bottom. This allow the labor and delivery health care providers to follow the fetal heart rate and how it responds to contractions. The relationship between these two is critical to health of the baby.

Electronic fetal monitoring is important because there are too many things that can go wrong during childbirth. The baby's condition can deteriorate rapidly during labor. This is why there is almost universal acceptance of EFM during childbirth.

The purpose of EFM is to see the warning signs and act on them before the child's brain and other vital organs suffer harm. The fetal monitor really is mostly about oxygen. If the fetal monitoring strips indicate that the baby does not have the oxygen it needs, doctors are often required to deliver the child right away by caesarean delivery. The failure take listen to what the baby is telling the doctors and nurses through the EFM leads to birth injury lawsuits.

What is fetal distress?

Fetal distress means the womb has become a hostile environment. The baby is not getting enough oxygen or any other nutrients. The fetus gets oxygen from the mother's oxygenated blood. This requires the transfer of oxygen from the mother's blood to the baby's blood. This is done via the placenta.

What are the signs of fetal distress or a non-reassuring heart rate?

The main signs of fetal distress are fetal bradycardia or tachycardia, late, persistent, or variable decelerations, and the absence of beat to beat variability in the heart rate. So many birth injury malpractice cases are the result of doctors and nurses going to extremes in the face of fetal distress. They either overreact or, more commonly, underreact.

What is a bradycardia?

Bradycardia is slowing of the heart rate below for a ten minute period of time. The marker is usually around 115-120 beats per minute. If a baby has severe bradycardia, the brain may not be getting oxygen. Brain damage starts approximately 10 to 17 minutes later. The variability in that range can depend on the strength of the baby's fetal reserve. If a baby who has full fetal reserve, it will take a longer bradycardia to produce an acute near total asphyxia than if the baby has weakened fetal reserves because the baby can sustain that bradycardia for a longer before brain damage begins.

Generally, if a baby can be delivered before 10-17 minute time period after a bradycardia, the child will do well. But if the baby experienced stress, evidenced by decelerations and other non-reassuring signs, the baby may not be able to withstand that final slowing of the heart rate and they don't have as much time.

What is tachycardia?

Child During Delivery Tachycardia is the opposite of bradycardia. Tachycardia is a heart rate greater than 150-160 beats per minute (bpm). A sustained heart rate above 150-160 suggests the possibility of fetal distress because a common cause of tachycardia is oxygen deprivation. A normal fetal heart rate should be somewhere between 115 and 150. Generally, a heart rate below 115 needs or over 150 needs to be evaluated. If the baby is in distress, the standard of care often requires the obstetrician to take immediate steps to deliver the baby.

Why is variability in the heart rate important?

The baby's vagus nerve slows down its heart rate. But a fetus does not have a developed vagus nerve like we do. So the fetal heart rate more irregular than ours. So a healthy baby will have up and down heart rate oscillations.

If the baby's heart rate does not have variability, it could because the baby is "asleep." During this their quiet time, they may have lack of variability. Some drugs can decrease variability. But lack of variability in conjunction with other evidence can be a sign the baby is in trouble because it is not getting the oxygen in needs.

What are decelerations?

Decelerations are drops in the fetal heart rate.

What is a late deceleration?

A late deceleration does not begin until the peak of the mother's contraction or after the contraction is completed. A 20 to 30 beats per minute drop qualifies as a late deceleration. The nurse monitoring the strips absolutely needs to let the OB know when the baby's fetal monitor shows a late deceleration a deceleration is a sign the back lacks oxygen and a C-section would be the safest course to protect the baby.

What is a variable deceleration?

A variable deceleration shows no regular heart rate pattern. They often involve sudden drops in the fetal heart rate that are often followed by just as sudden returns to the normal baseline rate. are characterized by a sudden, abrupt drop in thealong with usually a similarly abrupt return to baseline. They are often caused by umbilical cord compression. Variable decelerations are a concern but are less common and less worrisome than late decelerations.

What is the difference between an elective C-section and an emergency C-section?

An elective C-section is scheduled. For example, a mother having a repeat C-section or has a breach presentation. It is a C-section that's done either for clinical or maternal or fetal indications that is not an emergency. In this case, the mother or the baby is not in severe distress. Some malpractice cases are for failure to schedule a C-section. But most claims are for failure provide an emergency C-section when fetal distress signals call for one.

Getting a Lawyer for Your Malpractice Claim

If your child has suffered a birth injury and you believe a mistake was made, Ron Miller or Laura Zois today. We can talk about your options and what we can do for you. We have a track record of success in wrongful death and catastrophic injury medical malpractice cases. We can help you and your baby get the financial compensation you need and deserve. Call Miller & Zois today and speak to our Maryland birth injury medical malpractice attorneys at 800-553-8082 or get an online case evaluation.