June 27 2024: Newborn Brain Injury due to Failure to Deliver via Cesarean Section
On June 27, 2024, WVFK&N attorneys Christopher Norman and Gregory Kirby filed a medical malpractice claim on behalf of a newborn who suffered an avoidable brain injury.
The complaint alleges that, on October 27, 2022, our mother-client was urgently admitted to University of Maryland Medical Center for pre-eclampsia with severe features by blood pressure. She denied headache, visual disturbances, RUQ/epigastric pain, chest pain, shortness of breath, nausea, vomiting, new or worsening swelling, loss of fluid, vaginal bleeding, and contractions. She reported good fetal movement. At this time, she was pregnant with a baby with a gestational age of 33w2d. It was noted in her medical chart that our mother-client had chronic hypertension and a history of multiple kidney transplants, most recently in 2020 (this transplant was complicated by reimplantation of ureter due to post-operative leak. Fetal heart monitoring was reassuring.
After our mother-client was admitted, her providers created a plan of care: (1) give nifedipine 10 PO in setting of trouble getting IV, (2) put in an IV, (3) order pre-eclampsia labs, (4) monitor BP q15min, (5) start magnesium sulfate 4:1 in setting of impaired renal function, and (6) continuous toco/EFM. Further, our mother-client signed an informed consent form, indicating that she consented to different types of delivery methods, including Cesarean-section as an alternative to vaginal delivery. This form stated, “The physician … assisting in the delivery of the fetus will make the decision to implement other delivery methods based on his/her assessment of the medical necessity to safeguard the welfare of the fetus, the mother, or both.”
On October 28, 2022, the providers removed fetal heart monitoring due to the readings being consistently reassuring. The next day, the providers noted that our mother-client’s kidney transplant history is a concern that may affect the plan of treatment and again acknowledged that a Cesarean-section might be necessary. Fetal heart monitoring was restarted, and the readings showed minimal variability and repetitive, long decelerations. There was an 88-minute period during this critical period in which fetal heart tracings were not recorded.
Rather than calling a Cesarean-section in light of the extremely concerning findings, the providers recommended induction of labor in the setting of worsening pre-eclampsia with severe features manifested by worsening blood pressure despite medication and new onset nausea/vomiting and headaches. It was clear that our mother-client was remote from delivery, and both maternal and fetal statuses were non-reassuring.
Throughout the rest of the day and into the next day, our mother-client’s blood pressure and headache worsened, and she was given multiple administrations of a cervical ripening drug (misoprostol).
Variability remained consistently minimal, a Foley balloon was placed, and an epidural was administered due to our mother-client starting to experience painful contractions. Pitocin was started, and gradually increased, on October 30, 2022, and, that afternoon, her membranes were ruptured. Despite minimal variability, variable decelerations, and no accelerations, our mother-client’s plan of care remained the same, and the administration of Pitocin continued.
When it came time for our mother-client to begin pushing, she became concerned and reported pain and pressure. She also told her providers that something was wrong and did not feel right. Nonetheless, she was simply told to keep pushing. Fetal heart monitoring showed repetitive decelerations and periods of bradycardia. Finally, the providers performed an emergency Cesarean-section.
Our child-client was delivered limp and apneic with terminal meconium (it was noted that there was no infection present at the time of delivery). She had no respiratory effort, her heart rate was less than 100, she required intubation at about 2 and a half minutes of life, she required chest compressions, and she was administered a dose of epinephrine. Her APGAR scores were 0 at 1 minute, 2 at 5 minutes, and 3 at 10 minutes. Additionally, the providers initiated therapeutic hypothermia, but this was stopped prior to completion due to a concern for bleeding in the brain.
Today, our child-client suffers from hypoxic-ischemic brain injury, severe physical and intellectual disabilities, and seizures, and she is reliant on a permanent tracheostomy and a gastrostomy tube to survive. She is and will be permanently dependent on others for her care.
The lawsuit alleges that the injuries were a result of the negligence of University of Maryland Medical System Corporation d/b/a University of Maryland Medical Center, University of Maryland Medical Center, LLC, University of Maryland Faculty Physicians, Inc., and University of Maryland Obstetrical and Gynecological Associates, P.A. and their 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 Baltimore City in Maryland.
