Brain injury after delayed cesarean
A Massachusetts woman was 28 weeks pregnant when she presented to the hospital in 2004 with complaints of decreased fetal movement. The pregnancy was considered high risk due to her history of kidney disease and kidney transplant and the anti-rejection medications she was taking. She was admitted to the hospital with a fetal heart rate (FHR) that showed some decelerations. The next morning the FHR dropped into the 50–70 bpm range and the obstetrician was called and informed. He told the residents to continue monitoring the heart rate and to provide intravenous fluids to the patient. Later that day, the residents again called the obstetrician to inform him of the fluctuating FHR and the same orders were given. At 9:45 pm the FHR dropped and remained down for about 6 minutes. The residents ordered and performed an emergency cesarean delivery. At birth the infant required resuscitation and was transferred to the neonatal intensive care unit where she remained for 3 months. The infant suffered a severe brain injury and has spastic quadriparesis, uses a wheelchair, is unable to talk, is legally blind, and has both a permanent tracheostomy tube and a gastrostomy tube.
The patient sued those involved with the delivery and alleged that the obstetrician deviated from the standard of care by failing to timely deliver, or request delivery by another physician. She also alleged that the residents failed to properly evaluate and recognize the need for emergency cesarean delivery earlier in the day. She claimed the infant’s injuries were due to the lack of oxygen to her brain during the decelerations in the FHR.
The defense argued that the infant’s brain injury was due to an infection she contracted in utero, for which she was treated after delivery, and not the lack of oxygen.
The jury awarded the child $29.8 million in damages, and attributed all negligence to the attending obstetrician.
Perineal laceration after forceps delivery
A 34-year-old Illinois woman gave birth to her second child by vaginal delivery in 2010. She subsequently sued her obstetrician and alleged that he was negligent in failing to perform a cesarean after a prolonged second stage of labor and that he improperly utilized forceps to deliver the infant, which caused the patient to sustain a 4th-degree perineal tear extending into her rectum. She further claimed that he erroneously diagnosed the tear as a 2nd-degree laceration, delaying proper repair and resulting in contamination of the wound, infection, and failure of subsequent attempts at repairing the perineum. The patient suffered from persistent rectovaginal fistula for 5 years, requiring multiple operations.
The physician contended that allowing the labor to continue and using forceps for delivery was reasonable. He argued that the patient did sustain a 2nd-degree laceration during delivery and it was properly repaired, explaining that the 4th-degree tear occurred the next day due to attenuated perineal tissue.
The jury awarded the patient $11 million.