Legal: Failure to respond to FHR tracing

May 1, 2008

Failure to respond to FHR tracing

In 1996, a California woman was admitted to the hospital in labor. About 4 hours later, coupling of contractions with FHR decelerations were noted on the monitor. The obstetrician was notified. About 90 minutes later the baseline FHR had increased with more severe and frequent decelerations. Notified of these changes, the doctor reviewed the strips with the nurse and ordered oxytocin to be started. One hour later, the FHR rate flattened and was slower to return to baseline, and the nurses again reviewed the strips with the doctor. Three hours later, the nurses again notified the obstetrician of the progressing signs of fetal distress. The patient was 8-cm dilated and there had been no progress in the labor for the previous 2 hours. The doctor ordered the oxytocin increased and 45 minutes later the woman was 9 cm and was instructed to start pushing. The FHR showed decelerations to 60 bpm with each contraction. The doctor was told once again of persistent ominous signs of fetal distress, but asked the nurses to notify him when the baby began to crown and he went to take a nap.

After almost 2 hours, during which no progress was made, the nurses informed the doctor of this and that the decelerations continued while the patient was pushing. The doctor reviewed the strips and ordered an increase in the oxytocin. Almost 2 hours after this, the baby was delivered. The infant was noted to have a large amount of meconium in the trachea both above and below the vocal cords. Apgars were 2, 3, and 4 at 1, 5, and 10 minutes, and cord gases revealed acute severe metabolic and respiratory acidosis. The baby was admitted to the NICU with seizure disorder, cerebral edema with compressed ventricles, widening cranial sutures, and multi-organ dysfunction. He was diagnosed with cerebral palsy with right hemiplegia, and gross and fine motor dysfunction.

A lawsuit was filed and a $3.45 million settlement was reached, which included $1 million from the ob/gyn and $2.45 million from the hospital.