A 17-year-old woman with a history of miscarriage received prenatal care from her ObGyn. A July due date was established by ultrasonography in January.
In May, the mother went to the ED with pelvic pain. She was treated for preterm labor and discharged 2 days later.
In early July, ultrasonography showed a fetus in cephalic position with a posterior-located placenta.
At a prenatal examination a week later, the patient reported vaginal discharge. Her ObGyn suspected premature rupture of membranes (PROM) and admitted her to the hospital. Oxytocin was used to induce labor. Intact membranes were artificially ruptured and an internal fetal heart-rate monitor was placed. The ObGyn recorded that the pregnancy was at term.
Hours later, the mother told the nurses that she thought the fetal monitor had become disconnected; the monitor’s placement was not confirmed. The mother was given a sedative. After a few hours, she awoke with intense pain and dizziness. She used her call button, but no one immediately responded.
When full cervical dilation was reached, the fetus was at –1, 0 station. When the fetus reached +1 station, delivery was attempted. The baby was delivered using vacuum extraction.
The child’s Apgar score was 0 at 1 minute of life. Resuscitation was started with intubation and mechanical ventilation. The child’s birth weight was 6.87 lb; arterial blood gas pH measured 6.9; and gestational age was estimated at 38 to 39 weeks.
An electro-encephalogram performed in the NICU suggested intraventricular hemorrhage. The child was found to have perinatal asphyxia, hypoxic ischemic encephalopathy, left parietal skull fracture and cephalohematoma, severe metabolic acidosis, suspected sepsis, transient oliguria, and seizure episodes. The baby was hospitalized for 3.5 months and then followed regularly.
The mother and child moved from Puerto Rico to New York City to obtain better medical care. The child was regularly hospitalized until she died at age 5.
There was a discrepancy in gestational age assessment. The nurses failed to monitor fetal heart-rate tracings at proper intervals, and they were unresponsive to the mother. Informed consent did not include vacuum extraction.
The case was settled during trial.
A $1.125 million Puerto Rico settlement was reached.
These cases were selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements, & Experts, with permission of the editor, Lewis Laska (www.verdictslaska.com). The information available to the editors about the cases presented here is sometimes incomplete. Moreover, the cases may or may not have merit. Nevertheless, these cases represent the types of clinical situations that typically result in litigation and are meant to illustrate nationwide variation in jury verdicts and awards.
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