Clinical Review
10 tips for overcoming common challenges of intrapartum fetal monitoring
Use these expert tips to anticipate and address the common challenges of intrapartum FHR monitoring to improve care of the mother and baby and...
PARENT'S CLAIM: The pregnancy was at high risk because of the mother’s hypertension. The ObGyns misread the FHR at triage and discontinued FHR monitoring too early. If continuous FHR monitoring had occurred, fetal distress would have been detected earlier, resulting in a better outcome for the baby.
PHYSICIAN'S DEFENSE: There were no signs of fetal distress when the FHR monitoring was discontinued. Placental abruption is an acute event that cannot be predicted.
VERDICT: A Missouri defense verdict was returned.
Should the ObGyn have come to the hospital earlier?At 39 weeks’ gestation, a mother presented to the hospital for induction of labor. A FHR monitor was immediately placed. That evening, the ObGyn, who was not at the hospital, was notified that the mother had an elevated temperature and that the fetus was experiencing tachycardia. The ObGyn prescribed antibiotics, and the fever subsided. After an hour, the patient was fully dilated and started to push under the nurse’s supervision. Twenty minutes later, the ObGyn was notified that the fetus was experiencing variable decelerations. The ObGyn arrived in 30 minutes and ordered cesarean delivery. The baby was born 24 minutes later.
Ten hours after birth, the baby began to have seizures. He was transferred to another hospital and remained in the neonatal intensive care unit for 15 days. The child received a diagnosis of cerebral palsy.
PARENT'S CLAIM: The ObGyn was negligent in not coming to the hospital when the mother was feverish and the baby tachycardic. The baby experienced an acute hypoxic ischemic injury; an earlier cesarean delivery would have avoided brain injury.
PHYSICIAN'S DEFENSE: There was no breach in the standard of care. The infant did not meet all the criteria for an acute hypoxic ischemic injury. Based on a computed tomography scan taken after seizures began, the infant’s brain injury most likely occurred hours before birth.
VERDICT: A Virginia defense verdict was returned.
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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