Prenatal Asphyxia Requires Immediate Response
Klein, Cathy A
This article discusses two cases of neonatal asphyxia, and what a nurse practitioner can learn about prompt response and consequences of failure to respond properly.
* Case No. 1: Improper Response
The first case is out of Illinois. On January 12, 1995, a mother was admitted in labor to a suburban Chicago hospital and delivered an otherwise healthy son who suffered from birth injuries.
There were two family practice physicians attending to the mother during her labor and delivery. They were employees of the hospital and were not qualified to perform cesarean deliveries. Both family practitioners failed to respond in a timely matter to nonreassuring fetal heart rate tracings and failed to institute intrauterine resuscitative measures. They also failed to immediately call for an OB-GYN consult, or to marshal resources to perform an emergency cesarean section.
When they eventually called the OB-GYN, he further contributed to the baby’s injury by failing to perform an immediate cesarean section, delaying delivery by an hour and a half. At this time, the fetus was delivered vaginally, but only after five unsuccessful attempts at vacuum extraction.
As a result of the combined negligence of the family practitioners and the OB-GYN, the baby suffered brain injuries caused by intrapartum asphyxia. The child suffered permanent speech, language, cognitive, and behavioral deficits due to the hypoxic damage to his brain. The case was eventually settled for $4.5 million dollars.
* Case No. 2: Failure to Diagnose
The second case is out of New York. A mother was admitted to the hospital in labor on December 27, 1983. During the course of labor, the fetal monitor showed signs of bradyacardia three times. At one point, the fetal heart rate decreased to 90 beats per minute out of a normal 120 to 160 beats per minute.
The mother was brought to the delivery room for a forceps delivery, but rather than performing one, the obstetrical team waited for a normal spontaneous vaginal delivery. The baby was born 55 minutes later.
The fetal monitoring strips were not produced at trial. The plaintiff contended that the defendants were negligent for failing to diagnose protracted labor and fetal distress. The defendants denied negligence and contended there were no signs of brain damage after birth since the baby did not suffer from seizures, had no lack of tone, and did not require resuscitation. They further contended that the baby’s APGAR scores were 7 at 1 minute and 8 at 5 minutes. The plaintiff asserted these were not valid APGAR scores because they were not itemized. The child was 18-years-old at the time of trial and had spastic quadriaparesis and an auditory memory deficit. She walked with a severe limp but did not require orthopedic devices. The defendants argued that she only had spastic diplegia. The defendants were admonished at trial for not producing the fetal monitoring strips and received a missing document charge for their failure to produce the strips. The jury returned a verdict for $64 million dollars in favor of the plaintiff.
* Lessons Learned
What can be learned from these two cases? Reaction time is often short, and time is critical when bradyacardia, decelerations, or other signs of fetal distress are discovered. Act immediately. Act appropriately.
In the second case, the hospital lost the fetal monitoring strips. One could only speculate why the strips were lost-possibly to make it more difficult for the plaintiff to prove her case. However, in most jurisdictions, this would be considered expoliation of evidence, and can result in additional claims against a hospital, and the jury being instructed to construe all evidence usually contained in the strips against the hospital.
Cathy A. Klein, MSN, MSEd, APN, Esq.
Legal File Editor
Copyright Springhouse Corporation May 2004
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