This case involves a thirty-eight-year-old female who presented to the hospital at twenty-four weeks gestation, complaining of non-specific stomach pain. The medical notes suggested a possible etiology related to round ligament pain associated with body movements. The patient also reported some vaginal bleeding that started a few hours prior to her arrival at the hospital. The patient was started on magnesium sulfate, a steroid, and antibiotics, but was deemed not stable enough to be transferred to a tertiary care center. Upon application of the fetal heart monitoring device, the FHR was 180-185 for one minute and then decelerated to the eighties, but returned to the baseline for seventy seconds. The FHR remained between 110-120 for several minutes, and there were no accelerations noted with mild variability present on the tracings. Upon delivery of the infant, the baby was severely cyanotic and did not breathe spontaneously. The physicians provided PPV to the infant but the baby did not survive after resuscitation efforts. The belief is that the baby did not descend from the birth canal fast enough and suffered brain damage and respiratory failure.
Question(s) For Expert Witness
- 1. Was this patient properly managed and could this situation have been avoided?
Expert Witness Response E-000106
This case seems like the fetus presented in a breech position, which most likely led to the mechanical obstruction and prolonged delivery time. As soon as the delivery was determined to be difficult, portable radiographs should have been ordered to inform the practitioner if the fetal head was hyperextended and further investigation of the shape of the maternal pelvis and type of breech presentation could have been assessed. Limited bedside pelvic ultrasonography is the mainstay for fetal assessment, if breech presentation is suspected, and obtaining a sonogram to confirm or refute suspicions would have been a wise move in this situation. In addition to fetal presentation, a sonogram may reveal other fetal and/or uterine abnormalities which could have helped to ascertain why this was a difficult delivery.