Case Archive

Failure to Adequately Monitor Fetal Heart Rate Tracing
$10 Million Settlement

A 40-year-old woman's prior obstetrical history was significant for a C-section, vaginal birth after C-section (VBAC) with low forceps delivery, and two prior spontaneous abortions in the first trimester. She was Gravida 5, Para 2. She had 11 prenatal visits, which were unremarkable, as were lab tests. Informed consent in the records did not mention VBAC. The woman began spontaneous labor at term and was admitted to the hospital at 0325. The first stage of labor was normal. She was 10-cm dilated at +2 station at 0745 when the OB arrived. Previously the fetal heart rate showed intermittent loss of breakthrough bleeding (BTB) variability but was overall reassuring. Epidural anesthesia had begun at 0425. The OB left the patient and two nurses remained. At 0750 the fetal heart rate became non-reassuring, partly because the patient was squatting to push, which prevented a consistent read on an external monitor. At 0850 there was abnormal fetal heart rate tracing with wandering baseline and variable decelerations. At 0900 there was very abnormal racing. At 0912 the nurses contacted the OB. He arrived at 0940 and recognized the need for emergent forceps delivery, which was performed at 0954. The infant had APGARs of 1/3/4 at one, five and ten minutes of life. Cord blood gas had pH 6.71, PCO2 117, PO2 19, characteristic of hypoxia. The newborn diagnoses of diffuse neurologic injury, seizure, respiratory depression, and abnormal hepatic and renal function were compatible with this condition. All cultures ruled out infection. A medQuest OB/GYN reported the OB negligently failed at 0745 to remain with a high-risk patient attempting a VBAC. He failed to provide for appropriate physician coverage during the second stage of labor. Had he been present, the standard of care would have dictated emergent delivery by forceps of C-section upon recognition of the very abnormal fetal heart rate tracing after 0800. The two nurses negligently failed to recognize the abnormal tracing. Standard of care required they attach a fetal scalp electrode, administer oxygen and obtain immediate physician assistance. The negligence of the OB and the nurses caused an unnecessary and negligent delay in the delivery of the baby. The delay increased the duration of the fetal hypoxia that was the direct cause of the infant's severe and permanent injuries. The case was settled for $10 million.

Attorney for the Plaintiff:
Keith Lemons, Esq.
Lemons Law Firm, PLLC
Ft. Worth, TX

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