Mom was a 33-year-old woman who had a relatively uncomplicated prenatal course and was pregnant with her second child. Labour was induced at 39 weeks of gestation, however the physician did not obtain mom’s informed consent and failed to discuss the potential risks and benefits of proceeding with an induction. This failure to obtain the informed consent of the patient was a breach of the acceptable standard of care.
Once labour was stimulated, there was continuous uterine Tachysystole (Tachysystole is marked by more than five contractions per ten minutes over the course of 30 minutes, or when contractions last over two minutes). The Tachysystole persisted throughout labour and the delivery was extremely rapid – At 21:05 mom was fully dilated and at 21:07 the baby was delivered. Tachysystole poses a significant risk factor for fetal compromise due to asphyxia (deprivation of oxygen).
Further, throughout labour, nurses failed to properly monitor the fetal heart rate and doctors inappropriately administered various intravenous narcotics without first assessing the patient. If the fetal heart rate would have been properly monitored, it is almost certain that the non-reassuring fetal hear rate would have been identified and mitigating measures could have been taken.
As a result of the breach of the standard of care, baby was born in a severely compromised condition, suffered seizures, and required vigorous resuscitation. A diagnosis of severe Intrapartum (during labour) Hypoxic Ischemic Encephalopathy (“HIE”) was made. HIE is a type of brain dysfunction that occurs when the brain doesn’t receive enough oxygen or blood flow for a period of time. Prolonged Tachysystole is known to cause fetal HIE. As a result of the HIE, baby subsequently developed severe spastic Cerebral Palsy and is significantly delayed in development as a result.
During normal contractions, blood flow is diminished which prevents oxygen transfer from the mother to the fetus through placenta. This lack of blood flow is generally well tolerated, however, since the fetus receives sufficient oxygen after the placental blood has been replenished with oxygenated blood during diastole (the relaxed phase of the cardiac cycle when the chambers of the heart are re-filling with blood).
However, if contractions are too severe and/or too frequent (Tachysystole), fetal hypoxia-ischemia occurs and the fetus develops an oxygen debt, resulting in the utilization of fetal reserves to compensate for the hypoxia (hypoxia refers to low levels of oxygen in the blood). If the Tachysystole is ongoing, as it was in this case, there is an elevated risk of a hypoxic brain injury which becomes much more severe as labour proceeds.
Based on the brain imaging studies, baby had components of both a prolonged partial and an acute near total insult (i.e., a mixed pattern of brain damage). Had the doctors and nurses responded in an appropriate manner and properly managed the Tachysystole, the standard of care would have been met and baby would have been spared the intrapartum hypoxic ischemic insult and brain injury that led to the Cerebral Palsy.
Sommers, Roth & Elmaleh helped bring closure to the girl’s family, and ensured that the negligent doctors and nurses were held to account for the life-long damages suffered by the girl and her family.