Case Archive
 
Family Practice/OB
Ref. # 07387

A 21 year old Arkansas mother was in her third pregnancy; her first two children were normal. The prenatal course was complicated by an MVA in which the woman was thrown from a motorcycle riding at 40-50 mph, resulting in injury to the left hip and sacroiliac joint. During the next month there was persistent fluid leakage and contractions every 30-60 minutes, both of which eventually resolved. The mother presented at 0100 to a Level I Medical Center at 41 2/7 weeks gestation with contractions every two minutes. At 0245 she was 8-9 cm, 90% effaced. At 0250 she ruptured her membranes. Fluid was grossly meconium-stained. The mother was taken to Delivery at 0255. Her General Practitioner arrived at 0300. Spontaneous vaginal delivery occurred at 0306. According to the OB nurse the baby had spontaneous respirations and a weak cry. At 0307 Apgars were 1 & 4, indicating no spontaneous respiration. At 0313 the baby was DeLee'd. At 0317 oxygen was administered. At 0319 the GP attempted to intubate the baby but quickly gave up and called his associate for assistance. The second GP intubated the baby at 0333--27 minutes after delivery. Blood gas drawn showed severe acidosis (pH 7.079) and hypercarbia. At 0338 the baby extubated and was retracting with inadequate respiration. At 0350 he was reintubated. At 0420 the nurses were suctioning a large amount of meconium-stained fluid from the baby's lungs as the second GP attempted an arterial IV line, which was not in place until 0445. The baby was manually bagged through an ET tube. Transfer to a regional medical center was arranged and the baby left the hospital at 0545. The baby was subsequently air lifted to a major medical center and remained intubated for two months. Diagnostic brain imaging revealed extensive infarctions in multiple watershed regions. The child is now 10 with cerebral palsy. A medQuest family practitioner who performs prenatal care and deliveries opined the resuscitation attempts fell below the standard of care. Despite the low Apgars indicating a compromised child there was a lack of appropriate activity by the first GP. The baby should have been DeLee'd at the perineum or there should have been vigorous suction before he took his first breath. Furthermore, there was a negligent delay in transferring the baby to an appropriate medical center. A pediatric neurologist must review the medical records to determine the timing of the anoxic injury (i.e. post-delivery or after the MVA).




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