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Despite Warning Signs, Mom Gives Birth To Compromised Baby | Orange City Birth Injury Attorney

Despite Warning Signs, Mom Gives Birth To Compromised Baby

The fetal heart rate can tell doctors a lot about an unborn baby, which is why fluctuations in the heart rate are warning signs.

Unfortunately for this young mother, her baby’s heart rate was not monitored for the suggested length of time, and appropriate action was not taken during the delivery process when the baby’s heart rate showed marked deceleration.

The 23-year-old woman was sent home from the hospital twice during a 10-hour period after rupture of her membranes, before she returned a third time in active labor. The baby scored low in its initial wellness scores (APGAR) after birth, underwent a 25-minute resuscitation, and later developed profound neurological defects.

The patient’s parents sued the nurse midwife, the obstetrical nurses and the responding pediatricians, alleging that mismanagement of labor and delivery and the aftermath led to profound neurologic defects of the baby.

The mother settled the medical malpractice case against the nurse midwife for more than $1 million.

At 39 weeks gestation, the mother spontaneously ruptured membranes at 7:45 a.m. and went to the emergency department about an hour later. She was transferred to Labor and Delivery for evaluation and was seen by the nurse midwife on call.

The patient was deemed to not be in labor, and fetal well-being was thought to be assured. She was sent home at 9:45 a.m., having been advised to return when her contractions were closer together.

At about 11:30 a.m., the patient returned to Labor and Delivery with her husband, where she was re-evaluated by the same nurse midwife. The patient’s cervix was 1 cm dilated and 90% effaced. The fetal heart was monitored via electronic fetal heart monitor (EFM) for 13 minutes; the nurse midwife deemed the fetal heart rate pattern as unremarkable, gave the patient Benadryl, and sent her home, instructing her to return if her contractions did not increase by 7 p.m.

The patient returned by wheelchair to L&D at 6:45 p.m., grunting and bearing down. Her cervix was 9 cm dilated and 100% effaced. The heart monitor revealed a fetal heart tracing with marked variability in the baseline heart rate, fluctuating between 120-180, and notable for repeated decelerations to 90 beats per minute.

The patient labored for about two more hours before delivery occurred, during which time there were persistent, recurrent deep variable decelerations to 80-90 beats per minute. The nurse midwife delivered a baby boy at 9:01 p.m. with the Apgar’s wellness score of 1 at one minute and 3 at five minutes.

The baby initially appeared floppy. Resuscitation by the on-call pediatrician was successful after 20 minutes and the baby had his first spontaneous movement at 30 minutes of life. The baby was then transferred to a tertiary care facility where he experienced seizure activity.

A brain MRI confirmed findings consistent with hypoxic-ischemic encephalopathy, which means the baby’s brain did not receive enough oxygen. The baby developed additional symptoms of permanent neurological deficits, including blindness and a severe seizure disorder.

Points of interest in this medical malpractice case include:

Hospital policies did not address the minimum time required for fetal heart monitoring. When the patient returned the second time, electronic fetal monitoring was performed for 13 minutes before the patient was sent home again. Care standards suggest that the minimum time frame required to monitor the fetal heart rate and assess for fetal well-being is 20 minutes. Hospital policies must address minimum monitoring times and the need for evaluation by an obstetrician following rupture of membranes.

Early recognition of signs and symptoms of fetal distress did not produce the appropriate intervention. When the patient was finally admitted to Labor and Delivery, the fetal heart rate tracing was notable for repeated decelerations to 90 beats per minute. Despite these alarming decelerations, no other steps were taken to assess fetal status and the patient was allowed to labor for more than two hours with a persistently abnormal fetal heart rate tracing.

Medical providers did not timely recognize abnormal fetal heart rate patterns. When an abnormal pattern with persistent, recurrent, deep variable decelerations occurs, an obstetrical consult is appropriate to take measured steps that assure fetal well-being and delivery of the baby as expeditiously as needed.

For more on medical safety issues, see the library of articles by Daytona Beach medical malpractice attorney.

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