This case involves a C/S delivery of a full term girl to a 21 year old mother with only minimal prenatal care (4 pnc visits). She arrived at the hospital at approximately 4am on 4/7/14 with irregular ctx q10 min and a bloody show. She was admitted to the L&D from triage at 9am. The Assessment and plan was to admit, in early labor, administer Pitocin. At 1515 the administration of Pitocin began. However the Pitocin was put on hold due to Cat II tracings with repetitive variable decelerations. Pitocin resumed at about 21:00. The variable decelerations persisted and were referenced in the chart some of them deep down to 50bpm. Please refer to the attached pdf for additional info.
Files:
No questions yet!
Do you believe there might have been medical error?
It would require an obstetrician to opine on timing of delivery. The presence of a pediatrician or NICU personnel at delivery is dictated by local standard of care/hospital policy. Regardless, there needs to be an individual in the DR whose sole responsibility is to the neonates condition at birth and the capability of providing respiratory support. The 1st 2 blood gases may reflect cord gases. The others do not indicate if capillary or arterial. Neonatal management seems appropriate from the limited data presented.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
Initial blood gases appear reasonable. The infant is evaluated for possible sepsis because of maternal chorioamnionitis with a short NICU stay. Is there other evidence of organ system dysfunction?
What makes you a good expert for this case?
I am a board certified neonatologist with over 38 years experience. I have directed two Level III NICUs.
How often do you encounter cases similar to this one in your practice?
Chorioamnionitis is not uncommon. The management of infants born to women with chorioamnionitis is variable.
Do you believe there might have been medical error?
Based on the short history and summary provided I am unclear as to what the basis for proposed litigation is. What is the damage or injury to the baby? The notes do not describe what the baby has suffered. Possible points to be explored are the following: 1. How soon after the mother showed signs of chorioamnionitis did she receive antibiotics? 2. How soon after birth did the baby get the sepsis workup and get antibiotics? 3. Did the blood culture show any bacteria? 4. Was there any need for a spinal tap? 5. How was the initial bad blood gas managed?
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
Please read my questions above. If the answers to those questions reveal more information that is pertinent then there may be evidence of mismanagement
What makes you a good expert for this case?
I am a tenured Professor of Pediatrics and Neonatology at the University of Illinois at Chicago. Previously I worked at the University of California San Francisco and then at UCLA for 24 years. I am a physician scientist and have over 190 publications. As a Board Certified Pediatrician and Neonatologist who has had over 40 years of clinical experience in major University Hospitals I have encountered a myriad of complicated cases in neonatology. I was also the Head of the Department of Pediatrics and the Physician in Chief of our Children’s Hospital, and in that capacity I oversaw standards of care in all areas especially in the Division of Neonatology. I have served as expert witness in many cases, both for the plaintiff and the defendant, as well as testified in court. My biosketch and CV are available upon request.
How often do you encounter cases similar to this one in your practice?
These sorts of cases are very common and often I do see mismanagement as the initial care is often provided by a general pediatrician or an APN or a resident
Want to open a case or submit response?
Comments are accepted only from Pediatrics - Neonatal-Perinatal Medicine experts.