July 12 2024: Newborn Brain Injury Due to Failure to Timely Deliver
On July 12, 2024, WVFK&N attorneys Christopher Norman and Jonathan Huddleston filed a medical malpractice claim on behalf of a newborn who suffered an avoidable brain injury.
The complaint alleges that, on April 12, 2020, our mother-client presented to Howard County General Hospital (hereinafter “HCGH”) for induction of labor. She was pregnant with a baby with a gestational age of 40w1d. The indication for induction was noted to be gestational diabetes (GDM) (which was well controlled with diet). Otherwise, her prenatal care had been normal and uneventful.
Electronic fetal monitoring began that night, with an order for Pitocin being entered a few minutes afterwards. The Pitocin order came with instructions to “notify an authorized prescriber for any category II fetal heart tracings unresponsive to intrauterine resuscitation.” The Pitocin order also indicates that the dosage should only be increased until an adequate contraction pattern is reached (contractions occurring with a frequency of 3-5 per 10 minutes), with clear guidelines that each contraction should last less than 90 seconds, and that there should be at least 60 seconds of uterine relaxation between contractions.
Throughout the night, category II strips were recorded, as well as both variable and late decelerations. By the time our mother-client’s providers began Pitocin early in the morning on April 13, 2020, which was periodically increased throughout the labor course, she was already experiencing contractions occurring with an adequate frequency of 3-5 minutes and lasting for approximately 60-120 seconds. At 5:00 a.m., a nurse documented a category I tracing and contractions with a duration of up to 120 seconds. At this time, there was no resting time between contractions, and they were indeed lasting up to two minutes each. At 5:30 a.m., 06:00 a.m., and 06:30 a.m., a nurse documented her assessment of a category I tracing and continued to document that Ms. Jabbar’s contractions were lasting up to two minutes each.
Spontaneous rupture of membranes occurred at 6:40 a.m., which returned clear fluid with no odor. 50 minutes later, our mother-client experienced a pain level of 10/10 (i.e., “worst pain ever.”). Consequently, Pitocin was stopped, and an epidural was placed.
At 8:00 a.m., category II strips returned, this time with minimal variability. Pitocin was restarted 8 minutes later. Late and early decelerations were noted at 8:30 a.m. Nonetheless, the providers continued increasing Pitocin. The early decelerations lasted for approximately 3 hours, and during this period, there were many instances of intrauterine resuscitative measures. At 11:25 a.m., there was a 4-minute-long prolonged deceleration to a nadir of 90.
At 11:52 a.m., a few minutes after our mother-client was 10 cm dilated and 100% effaced, Pitocin was stopped, and fetal heart monitoring showed extremely concerning strips. Fetal heart rate decelerated to the 90s with pushing. Around this time, the providers discussed the use of a vacuum to deliver the baby. During this discussion, the providers did not inform our parent-clients of the non-reassuring fetal heart tracing or any other signs of fetal distress, and, despite there being many risks to the utilization of a vacuum in delivery, they informed our parent-clients that the only risk of utilizing the vacuum was molding of their baby’s head.
From approximately 11:40 a.m. through the time when the fetal heart monitor was removed at approximately 12:07 p.m., the strip was an extremely concerning category III tracing. At 12:01 p.m., the fetal heart rate decelerated to 60 beats per minute, and never returned to baseline. At 12:03 p.m., the vacuum was applied and the first attempt at vacuum-assisted delivery was made. A second attempt was made at 12:04 p.m., and a third attempt at 12:06 p.m. On the third pull of the vacuum, our mother-client began bleeding profusely from her vagina, which prompted the providers to transfer her to the operating room for a Cesarean-section at 12:08 p.m.
Our child-client was delivered at 12:17 p.m. via Cesarean-section. During the procedure, uterine and bladder ruptures were diagnosed. Placental pathology was unremarkable. Our child-client’s APGAR scores were 2, 6, and 8 at 1, 5, and 10 minutes, respectively, and her cord gases were profoundly acidotic (pH 6.75, BE – 15). Copious amounts of blood were suctioned from her lungs. At birth, she was encephalopathic, diagnosed with hypoxic ischemic encephalopathy, and transferred for head cooling.
Today, our child-client suffers from hypoxic-ischemic encephalopathy, severe physical and intellectual disabilities, and conscious physical pain and emotional anguish, and she will remain permanently dependent on others for all aspects of daily living.
The lawsuit alleges that the injuries were a result of the negligence of Howard County General Hospital, Inc. and its employees in failing to properly interpret the fetal monitoring strips, failing to appropriately monitor for, diagnose, and respond to evidence of fetal distress, and failing to timely order an earlier delivery via Cesarean-section.
The action is pending in the Circuit Court for Howard County in Maryland.
