Newborn Suffers Traumatic Brain Injury During Complicated Delivery


fetal monitoring chartThis case involves a 21-year-old patient who previously used Yasmin and with past medical history of spontaneous abortion. The patient began having contractions at 41 weeks and was on a fetal heart rate monitor. The baseline BPM was 128 with average long-term variability, positive accelerations and no decelerations. A few hours later, a prolonged deceleration was recorded. Two-hours later, it was noted that short term variability was absent, long-term variability was decreased and Pitocin was increased. Two-hours later, it was noted that the fetal heart rate dropped to 60-BPM. The defendant Obstetrician was at the bedside. Oxygen was provided and Pitocin was turned off. The fetal heart rate remained in the 60s and an emergency cesarean section was ordered by another obstetrician. The infant was delivered, Apgar scores were 1 at one minute; 1 at 5 minutes; 2 at ten minutes. The baby suffered a traumatic brain injury as a result of the delivery complications.

Question(s) For Expert Witness

  • 1. How often do you read and interpret fetal heart rate monitor strips?
  • 2. What constitutes a reassuring fetal heart trace?
  • 3. Could you review this patient's records and opine on your findings?

Expert Witness Response E-005991

I read and interpret fetal heart rate monitor strips on a daily basis. A reassuring fetal heart trace involves normal baseline, good beat to beat variability, accelerations, and no decelerations. It sounds like a tracing review is needed. More information is required about what the cord gases were, what the newborn course was, what the imaging studies show, and the current condition of the patient.

Expert Witness Response E-008270

I read and interpret fetal heart rate tracings on a weekly basis and could certainly review this patient’s medical records and opine on my findings. Given that the case occurred in 2005 and the guideline for interpreting these readings have since changed, I would examine these records through a different lens. Based on the case summary it seems that there may have been several red flags here. The absence of variability is never reassuring.

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