Medical Verdicts

Discordant fetal growth not noted


Unknown Massachusetts venue

On the day of delivery of twins at 35 weeks’ gestation, a woman went to her doctor’s office, where the nurse midwife administered a nonstress test. Because one twin’s heart pattern was nonreactive, the mother was sent for evaluation of premature labor.

It was revealed that the cover letter to a report from an ultrasound at 29 weeks reported concordant fetal growth, but numbers within the report differed from data in the cover letter and suggested discordant fetal growth.

Upon hospital admission, the woman’s cervix was 1.5 cm dilated and 100% effaced, with the presenting fetus at +1 station. The membranes were intact. The nursing notes indicated that the woman had been evaluated for labor in the morning and that the covering Ob was present, but did not mention that one fetus was nonreactive. After rupture of membranes and placement of an internal scalp lead on twin A (the presenting fetus), the covering Ob left the area and had to be called several times over the next 1.5 hours in response to late decelerations in twin A’s fetal heart rate. Scalp blood sampling on twin A revealed severe acidosis.

Delivered by emergency cesarean section, twin A was floppy, blue, and without respiratory effort. (Twin B was healthy.) Five days after birth a head ultrasound revealed a left germinal matrix hemorrhage in twin A, consistent with hypoxic ischemia. He remained in the NICU for a month. He now has cerebral palsy, visual and speech difficulties, and requires a walker and braces.

  • The case settled for $2.9 million.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn ( The available information about the cases presented here is sometimes incomplete; thus, pertinent details of a given situation may be unavailable. Moreover, the cases may or may not have merit. Nevertheless, these cases represent the types of clinical situations that typically result in litigation and are meant to illustrate nationwide variation in jury verdicts and awards.

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