Newborn Brain Injury Due to Delayed Delivery – January 2024
On January 18, 2024, WVFK&N attorneys Mary Koch and Sarah Smith filed a medical malpractice claim on behalf of a newborn who suffered an avoidable brain injury.
The complaint alleges that in the summer of 2015, the mother became pregnant. She was notably consistent with her prenatal care, attending appointments at least once a month from July to December, and her pregnancy was unremarkable throughout 2015. She also attended prenatal appointments in February and March 2016.
On March 4, 2016, at 40 weeks and two days gestation, the mother was scheduled for an induction of labor on March 12, 2016. On March 7, 2016, the mother presented to the Labor and Delivery unit at the University of Iowa complaining of loss of fluid. The mother denied contractions and vaginal bleeding and reported good fetal movement. The mother was noted to have intact membranes and a closed cervix; a nonstress test was reactive, and a nitrazine test was negative for the presence of amniotic fluid. She was discharged home.
On March 11, 2016, the mother presented to the University of Iowa for a scheduled appointment at 40 weeks and 6 days gestation. The mother reported a relative decrease in fetal movement, stating she “only [felt] fetal movement several times today” and denied loss of fluid, vaginal bleeding, cramping, and regular contractions. A nonstress test was nonreactive, though a contraction stress test was passed, given contractions were noted every 3–4 minutes without fetal heart rate decelerations. The mother was, therefore, referred to Labor and Delivery for induction of labor one day earlier than scheduled. Continuous fetal heart rate monitoring was initiated, and a sterile vaginal exam showed that the mother was not dilated, her cervix was long, and the baby’s station was “high.” A doctor ordered that she be administered Cervidil for cervical ripening.
On the morning of March 12, 2016, a resident noted that a sterile vaginal exam was deferred and that cervidil was removed with minimal cervical change. The resident consequently ordered Cytotec to be placed 3 times throughout the day, each dose 4 hours apart. Approximately 4 hours after the third dose of Cytotec was administered, the mother was 4 centimeters dilated and 1 centimeter effaced, and Pitocin was initiated.
Early in the morning on March 13, 2016, the mother had an epidural placed, and Pitocin was discontinued. Additionally, a doctor noted early and variable decelerations with 1 prolonged deceleration for approximately 2 and a half minutes. Pitocin was restarted, and despite the mother experiencing shortness of breath, palpitations, and continued decelerations, Pitocin was increased.
Artificial rupture of membranes was completed, and a fetal scalp electrode and internal uterine pressure catheter were placed to better differentiate between early and late decelerations. Approximately 8 hours after the epidural was placed, the mother was 6 centimeters dilated and 100% effaced. Approximately 3 hours after that, she was 8 centimeters dilated and 100% effaced.
In the afternoon, periodic late and variable decelerations began. The mother developed a fever and was administered ampicillin and gentamicin for presumed chorioamnionitis. Since the providers purportedly believed that fetal heart monitoring was reassuring, Pitocin was continued. As the afternoon went on, the fetal heart rates occasionally worsened, and the mother became 9 centimeters dilated and 100% effaced. The mother’s fever and administration of Pitocin persisted.
In the evening, Pitocin was decreased due to tachysystole, and the mother’s fever got significantly more severe. By the time the mother was 10 centimeters dilated and 100% effaced, the mother was exhausted as she had been pushing for 80 minutes. A doctor discussed the possible need for a Cesarean section but decided against it at first. The mother was ultimately moved to the
operating room for a Cesarean section approximately an hour and a half later. This decision followed “late-appearing decelerations” and consistently nonreassuring fetal heart monitoring.
The baby was delivered by cesarean section at 21:29 with Apgars of 2, 6, and 8 and required resuscitation in the operating room, including stimulation, suctioning, and positive pressure ventilation via CPAP. The NICU was notified at 6 hours of life and assessed the baby for potential for therapeutic hypothermia. The baby met the criteria for moderate hypoxic-ischemic encephalopathy on neurological exam, and cooling was initiated at 6.5 hours of life and continued for 72 hours per protocol.
Today, our child-client suffers from hypoxic-ischemic encephalopathy, developmental delay, and permanent severe brain damage. 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 the University of Iowa Health System, Inc. d/b/a University of Iowa Health Care d/b/a University of Iowa Hospitals and Clinics and its employees in failing to properly assess maternal and fetal status and failing to advocate for or timely deliver the mother’s baby by Cesarean-section.
The action is pending in the Iowa District Court for Johnson County.