This case takes place in Kentucky and involves a middle-aged mother who presented to the hospital while pregnant with her second child. At some point during her third trimester of pregnancy, the mother presented to the emergency room with complaints of headache, blurry vision, and dizziness. The patient was admitted to the hospital, at which point it was discovered that her blood pressure was extremely high. The patient was placed under observation, however she received minimal treatment and was not given any drugs to prophylactically treat pre-eclampsia. The patient was eventually induced. During labor she developed eclampsia, and suffered tonic/clonic seizures. As result, the infant was delivered vaginally with hypoxic brain injury.
Question(s) For Expert Witness
- 1. Do you routinely treat patients similar to the one described in the case?
- 2. Have you ever had a patient develop the outcome described in the case?
- 3. Do you believe this patient may have had a better outcome if the care rendered had been different?
Expert Witness Response E-007483
I frequently care for late preterm (34-37 weeks gestation) infants and well as infants whose birth complication results in hypoxic brain injury. I am very familiar with the standard of care in delivery room resuscitation, the provision of neonatal and convalescent medical care, and expected medical and developmental outcomes for these infants. Often times delaying delivery or proceeding with a vaginal birth (versus urgent cesarean delivery) can lead to very unfortunate outcomes, as appears to have occurred in this case. Depending on the course of events and how it was handled, the birth injury and poor outcome very likely could have been prevented.
Expert Witness Response E-001331
Yes, I routinely treat treat infants exposed to the maternal spectrum of pregnancy induced hypertension (PIH), pre-eclampsia, HELLP syndrome and eclampsia; in descending order based on frequency and modern perinatal care. I have cared for many infants with hypoxic brain injury as a result of various causes, including maternal seizures both as a result of eclampsia and other causes. It is impossible to give an unbiased answer to the question as to whether a better outcome would have occurred based on the care rendered without at least a cursory review of the actual medical record, however not performing a c-section in situations where the infant’s well-being may be in question can lead to injuries like those described here.