Case #4013 Failure to Perform A Timely Cesarean Section
On November 7, at 2:00 p.m., the Plaintiff, a 16 year old, presented to the Defendant Hospital at term, in labor with her first pregnancy. Her cervix was 5 centimeters dilated, 100% effaced and the baby’s head was at -2 station. The fetal heart rate was normal.
By 4:04 p.m., the Plaintiff’s cervix had progressed to 7 centimeters dilated, 100% effaced and at -2 station with bulging membranes — progress which was expected during labor. However, by 10:20 p.m., she had only progressed to 8 centimeters dilated, and the baby had not descended any further. At 11:35 p.m., the Plaintiff was still only 8 centimeters dilated. The Plaintiff alleged that the Defendant negligently failed to diagnose an arrest of labor and failure to progress due to cephalopelvic disproportion (where the baby’s head is too large to safely fit down the birth canal), and failed to perform a cesarean section at 11:00 p.m. Despite this failure to progress, no cesarean section was performed, and the Plaintiff was continued in labor with Pitocin (a drug to enhance contractions).
On November 8, at 2:34 a.m., the Plaintiff’s cervix was finally completely dilated, and the baby’s head had descended to +1 station, and at 3:00 a.m., she was then instructed to push. Less than thirty minutes later, the physicians determined that the Plaintiff was not pushing effectively due to maternal exhaustion and a vacuum extractor was placed on the baby’s head, suction was applied and he was pulled out to accomplish delivery. The Plaintiff further alleged that the Defendant’s use of the vacuum extractor was premature and contraindicated since the Plaintiff only pushed for less than thirty minutes, instead of one hour which is standard for first time mothers. The Plaintiff alleged that the Infant Plaintiff suffered trauma to his brain from a combination of the prolonged labor in the face of CPD which squeezed his head during descent and use of the vacuum extractor, leading to traumatic brain damage.
The Infant Plaintiff was born at 3:24 a.m. By 6 hours of life, he began desaturating with evidence of seizures and he ultimately required intubation. A CT scan of the brain without contrast that day revealed abnormalities in the parietal and temporal regions. In addition, there was evidence of a subdural hemorrhage and a cephalohematoma (scalp bruising) with superimposed soft tissue swelling over the scalp.
On November 12, a MRI of the brain without contrast revealed findings concerning for severe acute brain damage. On December 6, an MRI of the brain with and without contrast revealed extensive near global damage of the cerebral hemisphere. Physicians concluded that the Infant Plaintiff suffered with hypoxic ischemic encephalopathy and developmental delays. He is unable to control any of his movements or bodily functions, cannot sit or stand unsupported, has ongoing seizures despite medication, and has profound cognitive delays.
The Defendant denied that there was CPD or an arrest of labor since the Plaintiff ultimately became fully dilated and the baby’s head came down. The Defendant further contended that use of the vacuum was appropriate due to maternal exhaustion, and argued that the child’s injuries predated the Plaintiff’s labor.