Legal: Failure to perform emergency cesarean earlier

January 1, 2009

Cesarean section should have been performed sooner.

A 30-year-old California woman went to the hospital in 2005 for the delivery of her first child. She was past her due date, but non-stress tests done as recently as 2 days earlier had been normal and FHR on arrival was normal. She was under the care of a midwife and a labor and delivery nurse. The patient reported severe pain and about 6 hours after her arrival, she requested a cesarean due to the pain. The nurse recorded the request, but did not convey it to the midwife or obstetrician in the unit. Some meconium was noted with SROM and an amnioinfusion was started when she was 4 cm dilated. After 24 hours in the hospital, the patient's temperature was noted to be 100.2°F. Four hours later, a nurse noted decelerations of FHR and the midwife was informed. The midwife called the obstetrician and an emergency C/S was done. Apgar scores were 1, 5, and 5. The placental pathology report showed acute chorioamnionitis and acute funisitis. The cord blood gases were normal. The infant had profound developmental delay with static encephalopathy as a result.

The woman sued those involved with her care and claimed they were negligent in failing to perform a timely C/S.

The defense claimed that there was no medical indication for a C/S as long as the fetal monitor strip was reassuring. They also claimed that the injury to the fetus was due to the infection in the placenta and cord. A $3.5 million settlement was reached.