Subdural hematoma diagnosed after delivery

In 2001 a New York woman arrived at the hospital in labor 9 days past her due date. She was examined and determined to be in early labor and was placed on a fetal monitor; about 90 minutes later her membranes were artificially ruptured and slight meconium was noted. She delivered vaginally an infant weighing 8 lb 5 oz with Apgar scores of 9. Over the first 4 days the child appeared fine, but did not feed well. On the fourth day, he was admitted to the NICU for poor feeding and experienced abnormal limb movements and fist clenching. At 6 days a CT scan was performed, which revealed axial hemorrhage associated with bony disruption and showing evidence of a right-sided subdural hemorrhage. The report noted the findings were consistent with birth trauma. Later that day, the infant was transferred to another hospital where an MRl revealed a subdural hemorrhage, but did not show a bony disruption or evidence of birth trauma. The child has cerebral palsy with some autistic features and difficulty walking.

In the lawsuit that followed, the patient claimed that negligence during the delivery led to birth trauma and the child’s difficulties. The matter ultimately was against only the hospital corporation. The patient and her sister, who was present at the birth, claimed the nurse midwife pulled, tugged, and had difficulty during the birth.

The defense denied there was birth trauma and claimed that both the Apgar scores and MRl findings were consistent with a delivery that was not traumatic. Nevertheless, a settlement was reached during mediation for $1.1 million.

Improper use of vacuum extractor claimed to extend injury to perineum

A 27-year-old Georgia woman became pregnant for the first time in 1998. She was seen by her obstetrician and had an essentially uncomplicated prenatal course. She went into labor at term and was admitted to the hospital. She was placed on an FHR monitor and received an epidural; her labor was augmented with oxytocin. The infant, delivered with a vacuum assist after 4.5 hours of second stage, weighed 8 lb 5 oz. The patient had a third-degree perineal laceration, which was immediately diagnosed and repaired. The patient did well after delivery and was examined in the hospital before discharge with no problems noted at the site of the tear. She subsequently had intermittent episodes of fecal incontinence, which she mentioned at her 1-month postpartum visit. Her physician said that the problem would resolve itself, but told the patient to keep her updated. When the patient reported that her symptoms persisted, she was referred to a colorectal surgeon. She underwent surgical repair, but was not satisfied with the outcome and sought a second operation from another physician.

She sued the original delivering physician and claimed that her second stage of labor was mismanaged and that a vacuum should not have been used, but rather a cesarean section should have been performed. The woman also argued that the perineal tear was negligently repaired and the physician failed to provide proper follow-up care.

The obstetrician contended there was no negligence and the delivery and tear repair were both properly performed. A defense verdict was returned.

—Department Editor Dawn Collins, JDMs. Collins is an attorney specializing in medical malpractice in Long Beach, CA.
She welcomes feedback on this column via email to DawnCF@aol.com.