Legal: Intracranial bleed after delivery

November 1, 2008

An infant had a shoulder dystocia and was diagnosed with spastic quadriplegic cerebral palsy.

An infant delivered at a Tennessee medical center in 1999 had a shoulder dystocia and was subsequently diagnosed with spastic quadriplegic cerebral palsy. In the lawsuit that followed, the claim against the delivering obstetrician was that he negligently used a vacuum extractor and forceps during the delivery that caused subdural and subarachnoid bleeding, which with the shoulder dystocia, resulted in a period of hypoxic ischemia that in turn caused permanent brain damage. As to the hospital, the suit claimed the nurse failed to adequately monitor the FHR and convey information to the physician, and she improperly applied fundal pressure causing the shoulder dystocia, and that a history of improper conduct should have resulted in her termination prior to this delivery.

The obstetrician argued that use of the vacuum extractor and a single application of forceps was proper, and the amount of bleeding shown on imaging studies was insufficient to cause permanent brain injury alone or in combination with any hypoxia resulting from the shoulder dystocia. He claimed the shoulder dystocia was unforeseeable and properly managed when it occurred, that the infant was delivered within 3 minutes and this was too short a time to cause hypoxic-ischemic encephalopathy or produce permanent central nervous system damage or cerebral palsy. The hospital generally denied any negligence by its employees. It was sanctioned by the court for failing to comply with orders requiring it to produce documents relative to the nurse's behavior and when it did so, they showed allegations of improper conduct that occurred after the date of this delivery. The hospital claimed that any bad acts in these documents had nothing to do with the delivery at issue in this case, and a defense verdict was returned.

Department editor DAWN COLLINS, JD, is an attorney specializing in medical malpractice in Long Beach, CA. She welcomes feedback on this column via e-mail to dawncfree@gmail.com
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