Defense denies dystocia, says baby was “hung up”
Cook County (III) Circuit Court
Shortly after vaginal delivery of a 9 lb 7 oz infant by a 31-year-old woman, the infant was found to have a fractured clavicle, a limp right arm, and bruising on the upper shoulder and back. The physician’s notes stated the delivery was normal, with no shoulder dystocia and no difficulties. The physician allegedly advised the parents that the infant had a “stretched nerve” that would resolve over time, and that nerve injuries took a long time to heal.
After 3 years, the child was diagnosed with brachial plexus injury, arm shortening and weakness, and dexterity problems. The child had had 2 corrective surgeries, and further surgeries and physical therapy were expected to be necessary throughout her life. The plaintiff claimed the shoulder dystocia was a result of excessive traction by the physician, and that the physician failed to recognize the shoulder dystocia and take appropriate action.
The physician insisted the natural propulsive forces of labor caused the injury. He denied encountering shoulder dystocia, although he stated on cross-examination that the baby got “hung up” during delivery.
- The jury awarded the plaintiff $3 million.
Resident lacerates infant’s forehead
Queens County (NY) Supreme Court
A 26-year-old woman was admitted with labor pains and was attached to a fetal heart monitor. Because the fetus had mild tachycardia (
The obstetrician made a Pfannenstiel incision and a third-year resident made the uterine incision, lacerating the forehead of the fetus to the bone. The laceration was 5 cm long and required 30 stitches immediately after birth.
The woman asserted she was not advised until moments beforehand that a cesarean section was to be done, and that she was never told that a resident would make the uterine incision. She also claimed negligence on the part of the obstetrician for failing to perform an internal exam to assess the thinness of the uterine wall.
The physician argued the high fetal heart rate necessitated a cesarean section, which became an emergency when general anesthesia was given.
- The jury awarded the plaintiff $550,000.
Necrotizing fasciitis after c-section
Suffolk County (Mass) Superior Court
After a 34-year-old primigravida underwent a cesarean section, a surgical incision and deep infection developed. Ten days after delivery, and after several readmissions for the infection, she was transferred to a teaching facility in critical condition, where necrotizing fasciitis was diagnosed immediately. Major debridement of the abdominal wall was repeated several times over the next 5 weeks, and her infected uterus was removed. Reconstruction was necessary to repair the abdominal wall and loss of skin.
The woman claimed negligence in failure to diagnosis postpartum endometritis; she maintained the physician had said the infection was under control just before transfer to the teaching hospital. She faulted the physician for failure to use the standard antibiotic treatment for endometritis, failure to promptly open and drain the surgical wound because of cellulitis, failure to switch antibiotics in the face of progressing infection, prematurely discharging her on 2 occasions, and failure to recognize and treat necrotizing fasciitis despite skin hardening and other classic signs.
The physician contended that necrotizing fasciitis is rare and difficult to diagnose due to its similarity to other infections, and that it developed either just before or during transfer out of his care. The defense maintained the woman was always on antibiotics in consultation with infectious disease and wound care experts.
- The case settled for $500,000.
Finger-pointing after high-risk birth
Orange County (Calif) Superior Court
A woman with gestational diabetes, pregnancy-induced hypertension, preeclampsia, fetal prematurity, and intrauterine growth restriction was admitted at 36 weeks’ gestation to a hospital for induction of labor. She was seen by a physician at 5, 14, and 23 hours after admission.
During the induction, fetal monitoring strips became nonreassuring. The on-call OB was allegedly contacted 3 times by the labor-delivery nurse, but he was delivering a series of infants at another hospital. The nurse then contacted the back-up OB, who arrived 40 minutes later.
Delivered by vacuum extraction, the infant had Apgar scores of 6 at 1 minute and 7 at 5 minutes; cord blood pH was 7.15. The infant had seizures in the NICU and brain imaging evidence of subdural and subarachnoid bleeding and an enlarging clot in the transverse sinus and in the superior sagittal sinus. A month later at discharge, the infant was diagnosed with severe cerebral palsy.
In suing, the woman claimed that her complications should have warranted closer monitoring to ensure a safe trial of labor. She also contended the on-call OB should have arranged for the back-up OB to see her.