Child has congenital disorder after negative prenatal testing … and more
PATIENT’S CLAIM The ObGyn never discussed the risk of a large baby. Three weeks before delivery, ultrasonography estimated fetal weight at 9 lbs, 2 oz. The mother asked if cesarean delivery would be safer; the ObGyn responded that he believed the child weighed less than 10 lbs, and that a vaginal delivery would be appropriate.
PHYSICIAN’S DEFENSE The ObGyn did not offer cesarean delivery because he believed there was no medical necessity for that discussion.
VERDICT A $1,174,365 Ohio verdict was returned.
Despite gastroschisis, neonatal team called after birth
ULTRASONOGRAPHY showed fetal gastroschisis with a moderate amount of exposed bowel. The mother went into labor at 38 weeks. Electronic external fetal heart-rate tracing showed fetal bradycardia at 60–70 beats per minute (bpm). When the membranes were artificially ruptured, the amniotic fluid was full of thick meconium. A fetal scalp electrode showed a heart rate of 30–120 bpm; a second electrode confirmed the range.
The baby was delivered vaginally with Apgar scores of 2, 2, and 4 at 1, 5, and 10 minutes, respectively. The newborn was depressed, flaccid, blue, and unresponsive, with thick meconium below the vocal cords.
When the neonatal intensive care unit (NICU) team arrived, the baby was making no respiratory effort, and had a heart rate of 60 bpm. Meconium blocked the airway; he was intubated at 4 minutes of life. Arterial blood
sampling showed severe metabolic acidosis from hypoxia. Gastroschisis ruled out fetal cooling, which might have ameliorated the brain injury. The child suffered hypoxic ischemic encephalopathy from intrapartum asyphyxia that led to microcephaly. He requires a feeding tube and lifetime care.
PATIENT’S CLAIM Knowing that gastroschisis was present, the NICU team should have been called to the patient’s bedside before her membranes were ruptured. A cesarean delivery should have been performed when fetal distress was evident.
DEFENDANTS’ DEFENSE The case was settled before trial.
VERDICT A $2.8 million Virginia settlement was reached: $1.8 million for the child; $1 million for the mother.
Twin-to-twin transfusion syndrome
A WOMAN EXPECTING TWINS had multiple ultrasonographic studies during pregnancy; all were read as normal. The babies were born prematurely and both died shortly after birth.
PATIENT’S CLAIM The radiologist and two ObGyns failed to correctly analyze the sonograms and diagnose and treat twin-to-twin transfusion syndrome.
PHYSICIANS’ DEFENSE The case was settled before trial.
VERDICT A $375,000 Virginia settlement was reached.
