This case involves a twenty-eight-year-old pregnant female who presented to the labor and delivery unit of a hospital complaining of contractions. Upon admission, the fetal heart rate monitor showed a heart rate of 125-140 as the mother had contractions every two to four minutes. Approximately one hour later, the monitor showed persistent variable decelerations, which prompted caregivers to move the patient to her left side. An hour later, the decelerations persisted and the patient was moved to her right side. Two hours later, a cervidil was inserted and monitors were still showing subtle decelerations. Plans for a C-section were discussed with the patient but did not take place for an additional two hours. The baby was delivered via C-section with Apgar scores being one, six, and eight. The initial pediatric neurology note indicated that the infant was deeply cyanotic with no spontaneous movement evident. The baby developed oliguria with associated protein and blood loss in the urine. A head ultrasound was performed that demonstrated cerebral edema and an MRI indicated severe hypoxia.
Question(s) For Expert Witness
- 1. Did the physician's decision to wait several hours before delivering via C-section contribute to this infant's illness?
Expert Witness Response E-005707
If one of the arrest or protraction disorders is identified, which seemed to be the case here, and there is a failure to respond to conservative measures, or if the fetal heart pattern is nonreassuring, expedient delivery is justified. This includes operative vaginal delivery or cesarean delivery as indicated. Operative delivery with use of forceps or vacuum must be performed by an experienced provider. One should be aware of the increased associations for shoulder dystocia and neonatal injury with operative vaginal delivery in the setting of abnormal labor. I believe there were multiple signs that this delivery was complicated and the physicians may have waited too long in opting for a C-section to prevent neonatal injury.