Mom presented to the hospital 10 days following her due date and was in active labour. Over the course of her labour, from admission to delivery, several events occurred that did not follow the appropriate standards of care.
Mom was allowed to remain in active labour for a lengthy period, during which there were indications that the fetus was in distress and should be delivered promptly. This was not done. The fetus was experiencing Tachycardia (an abnormally fast heart rate. The normal fetal heart rate is between 120 and 160 beats per minute. An abnormally fast heart rate is over 200 beats per minute). As a result of the delay in delivery, the fetus was significantly compromised in utero. The brain injury that occurred was made worse as the fetus remained undelivered.
Several events led to the distress of the fetus, and ultimately, to the brain injury:
The nurses did not call a physician when they recognized that there was an abnormal heart rate.
The nurses started and continued the administration of oxytocin (a hormone used to facilitate childbirth) when it was contraindicated in the circumstances. The nurses also initiated oxytocin while the fetus was experiencing Tachycardia without consulting a doctor first.
The nurses failed to initiate resuscitative measures for the well-being of the fetus.
The standard of care is to monitor the fetal heart rate every 15-30 minutes during active labour. This did not occur between 04:26 and 05:30.
Further, with respect to the physicians, Dr. A failed to take appropriate measures when the fetal heart rate strip showed abnormalities and allowed oxytocin when it was contraindicated in the circumstances.
Dr. B allowed mom to remain in labour for several hours without seeing her to assess the condition of the fetus. When he did see her, he did not take immediate steps to deliver the fetus, nor did he examine the fetal monitor tracing.
Dr. C was aware of the abnormal heart rate of the fetus, but failed to examine the mother or take further steps considering the status of the fetus. Dr. C similarly allowed administration of oxytocin to continue when it was contradicted in the circumstances.
Throughout labour, there was a concerning lack of documentation with respect to appropriate nursing interventions when the fetal heart rate was non reassuring, and with respect to the notification of physicians during these times. An abnormal fetal heart rate necessitates that a physician be notified. This did not happen in this case.
Baby was born in a severely compromised condition and was described as “flat” with cyanosis (a bluish-purple hue to the skin), without any respiration and required immediate vigorous resuscitation with intubation and ventilation.
As a result of the substandard care during labour, namely the delay in delivery, baby was diagnosed with intrapartum (the portion of pregnancy that occurs during labour) Hypoxic Ischemic Encephalopathy (a type of brain dysfunction that occurs when the brain doesn't receive enough oxygen or blood flow for a period of time), which ultimately led to the development of Cerebral Palsy and Epilepsy.
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