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    Legally Speaking: Infant death from fetal hydrops




    Ms Collins is an attorney specializing in medical malpractice in Long Beach, California. She can be reached at [email protected].


    Infant death from fetal hydrops

    An Illinois woman was admitted to a hospital in 2009 at term in labor. She was under the care of nurses and residents who were supervised by an attending physician. During labor, the residents and the nursing staff documented late and variable decelerations on the fetal heart rate (FHR) monitor with periods of minimal or undetectable variability. However, the FHR was reported as being reassuring overall.

    At approximately 3 am the next day, after the patient had been pushing for an hour and a half, the FHR became nonreassuring and the senior ob/gyn resident contacted the attending ob/gyn to perform the delivery. The delivery was accomplished using a vacuum extractor. The neonatologist in the delivery room noted that the infant, who had no signs of life, appeared to be hydropic with generalized edema, ascites, and pleural effusion. The neonatologist performed a thoracentesis but the infant died several hours later. According to the neonatologist, the cause of death was hypoxic-ischemic encephalopathy (HIE) and multi-system organ failure. The pathologist who performed the private autopsy 3 and a half weeks later concluded that the infant’s cause of death was congestive heart failure.

    A lawsuit was filed on behalf of the infant alleging that the attending obstetrician and the residents deviated from the standard of care by failing to appropriately communicate with each other, failing to recognize abnormal FHR tracings and fetal distress, and failing to perform a cesarean section, due to non-reassuring FHR tracings, to deliver the infant sooner. The expert neonatologist for the plaintiff opined that due to the physician’s negligent failure to timely deliver the infant, she developed severe intrauterine hypoxic ischemia that resulted in fetal hydrops and subsequent death.

    Related: SMFM Guidelines: Nonimmune hydrops fetalis

    The physician and hospital contended that the FHR tracings were overall reassuring and that the obstetrical team communicated appropriately and kept the attending physician alerted as to the patient’s status. They argued that there was no need to deliver the baby any sooner and that the procedure was expedited. Further, they asserted that the fetal hydrops is the end manifestation of a serious problem in utero that could not possibly develop within several hours during the labor and delivery time frame and most likely took at least days to weeks to develop. The defense concluded that there was no hypoxic ischemic encephalopathy and that fetal hydrops was the cause of death as shown by the autopsy.




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