Legal: Change in FHR status allegedly missed

May 1, 2009

A woman admitted to the hospital in labor had reassuring FHR monitor strips.

In 2005, a Wisconsin woman was admitted to the hospital in labor. The fetal heart rate monitor strips had been reassuring when a new nurse-midwife took over her care. Because the patient had been 5-cm dilated at 0500 hours and no change had occurred in 3 hours, oxytocin was started and at 1600 was almost complete. The woman was instructed to start pushing around 1620.

Shortly after this, the FHR became nonreassuring, with multiple decelerations and a change in baseline rate. The nurse in charge noted it was difficult to determine the baseline FHR and that she could not tell if there were accelerations or decelerations. When the mother became exhausted around 1800, the nurse-midwife sought the assistance of the on-duty obstetrician, who had never seen the patient. The ob/gyn chose to perform a vacuum delivery. When she applied it around 1816, the fetal monitoring pattern became ominous, and the infant was delivered at 1848 severely depressed, cyanotic, and nonresponsive. Immediate resuscitation began. Apgar scores were 3, 3, and 3, with a cord blood pH of 6.98. The child suffers from severe cerebral palsy, is nonambulatory and nonverbal, is fed through a G-tube, and has had a fundoplication.

In the lawsuit against the nurse-midwife, obstetrician, and hospital, the patient claimed that the defendants failed to recognize the change in FHR status and lack of progress of labor, which should have resulted in a cesarean delivery. She further charged that the delay in delivery led to severe metabolic acidosis and the resulting brain damage.