Preterm delivery results in CP
A Michigan woman with a history of cesarean delivery at 24 weeksâ gestation was offered synthetic progesterone injections at the beginning of her prenatal care in a subsequent pregnancy. She claimed she could not afford the injections. Three weeks after her initial visit, she returned to the high-risk clinic and was again offered the progesterone injections, which she rejected. During her return visit, 4 weeks later, her cervical length on ultrasound was 3 cm. She again declined the progesterone. At a follow-up visit 2 weeks later, the womanâs cervical measurement was 2.5 cm. and she once again did not consent to tprogesterone injections. Another ultrasound done 2 weeks later showed a cervical length of 1 cm. The woman was admitted to the hospital but before any orders could be written to for tests to rule out early labor and/or delivery, she left the hospital to care for her other children. She was to return after arranging care for them, but did not come back. Five days later the womanâs cervical length was 1 cm and she received a progesterone injection. Over the next 4 weeks, had 4 more injections but she did not return for the fifth or cervical measurement.
The day after the womanâs missed appointment, she presented to the hospital with cramping. She was admitted and given steroids and medication to stop the contractions. An ultrasound showed that the fetus was breech. The patient consented to a cesarean, but before the procedure was started, the baby was born vaginally. The child suffers from mild brain damage, cerebral palsy, developmental delays, and learning disabilities.
The woman sued those involved with her care during the pregnancy and alleged that the healthcare providers should have offered her vaginal progesterone, which was less expensive than the injections, that steroids should have been given to her earlier to improve neonatal development, and that vaginal delivery should have been prevented.
The defense argued that the infant delivered precipitously on the way to the operating room.