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    Were these infant’s delays secondary to misapplication of a vacuum extractor?

    Andrew I. Kaplan, Esq. is a partner at Aaronson, Rappaport, Feinstein & Deutsch, LLP in New York City, specializing in medical malpractice defense and health care litigation. Mr. Kaplan is a regular contributor to this column.


    The patient was 37 years old in 2006 when she became pregnant. She was also morbidly obese, weighing over 330 pounds. Starting on February 24, co-defendant Dr. A. managed her prenatal care. At first, the patient’s expected due date was set as October 6. Then at 34 weeks gestation, she developed oligohydramnios. An ultrasound on August 23 confirmed a low amniotic fluid index (AFI) of 5.6, and she was referred to Defendant Hospital for hydration.

    That same day she was admitted to Defendant Hospital where she received intravenous fluids. The next day, a repeat ultrasound revealed that her AFI had decreased to 4.8, despite the administration of fluids. At the same time, there was normal fetal growth and she was judged to be 34 weeks pregnant. Faced with the risks of oligohydramnios for the remainder of her pregnancy, including possibilities of restricted growth and labor complications, the decision was made to deliver.

    On August 24, the patient received Betamethasone and Cervidil. At 3:00 AM the following morning the Cervidil was removed. Next, Pitocin was commenced at 8:30 AM. A second dose of Betamethasone was given at 3:30 PM. At 4:15 PM there was a deceleration noted on the fetal tracing with good return to baseline. A fetal scalp electrode was applied at 4:30 PM when the mother was 4 centimeters (cm) dilated. At this point, the fetal monitoring strips were reassuring. There was a good fetal heart rate and accelerations that signified fetal wellbeing.

    The mother dilated quickly to anterior lip by 5:13 PM. At this time, she had a 90-second deceleration due to cord compression, followed by a good return to baseline and then at 5:46 PM some mild variable decelerations. After 2 more variable decelerations at 6:02 PM, defendant Dr. B. decided to perform a vacuum extraction. With 1 quick pull of the extractor, measured at an appropriately negative pressure of 60 millimeters of mercury, he delivered the infant from the +4 station.

    At birth the infant weighed 5 pounds and 6 ounces. His Apgars were 7 at 1 minute, and 8 at 5 minutes. Pediatricians were present during the birth because he was premature. He did not need to be intubated and was transferred to the NICU. When there, the infant had some decreased tone and elevated bilirubin levels. The bilirubin was treated with double phototherapy lights, which help lower bilirubin levels. The infant also required a CPAP while in the NICU.

    On September 1st, the 5th day of life, an ultrasound of the head was within normal limits. On September 5th, the 11th day of life, an MRI revealed a grade II intraventricular hemorrhage in the cortico-thalamic region.

    The infant was diagnosed with hypotonic cerebral palsy, static encephalopathy and developmental delays. Though at first he needed leg braces to walk, he has recovered to the point where he now walks and runs without assistance. He does so with a slight diplegic gait, with mildly increased tone in the lower extremities that affects his left side less than his right. He scored a 66 on an IQ test at 4.5 years old.

    NEXT: Allegations and Discovery

    Andrew I. Kaplan, Esq
    Mr. Kaplan is a partner at Aaronson, Rappaport, Feinstein & Deutsch, LLP, specializing in medical malpractice defense and healthcare ...


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