On April 8, 2013, a 32-year-old patient presented to the defendant hospital clinic for a pregnancy test, which was positive. Her estimated date of confinement (EDC) was November 15, 2013 and the gestational age was noted to be 8 weeks, 3 days. On April 30, 2013, the patient presented for her initial obstetrical visit accompanied by her husband. Examination was within normal limits and the fetal heart rate (FHR) was 170. Routine prenatal labs were ordered, first-trimester screening (FTS) was scheduled for May 1, 2013, and the patient was instructed to return to the clinic in 4, 8, and 12 weeks. Over the following 5 months, she visited the clinic for prenatal care eight times and all of the findings were relatively benign. In brief, on June 10, 2013, a fetal anatomical survey was performed.
On October 10, 2013, the patient returned to the clinic for her last prenatal visit at a gestational age of 34 weeks, 6 days. She reported doing well but also said she was feeling the baby less that day than she had the prior night. She reported no contractions or loss of fluid, and some dysuria a few days previously but not that day. The patient denied headache, vision changes, epigastric pain, and/or right upper quadrant pain. Fundal height was 32 cm and fetal heart tones were in the 160s. Questionable growth restriction was noted as fundal height was unchanged since the last visit. The patient was referred for a growth scan in 1 week and was to return for a visit in 2 weeks.
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On October 11, 2013, the patient presented to the clinic and reported decreased fetal movement. On external fetal monitor the baseline was 150, with minimal variability, no accelerations, and positive decelerations. Flowsheets in the chart document findings from the tracings every 15 minutes from 20:30 to 23:45. From 20:30 to 22:00, the fetal heart rate (FHR) baseline was 145 to 155; variability was minimal; accelerations were absent except for at 21:45, when they were noted to be spontaneous; there were no decelerations. At 22:15, the FHR was 150 with a deceleration to 90 for 90 seconds, variability was moderate, accelerations were absent, and decelerations were noted to be variable.