Legal Briefs: Catastrophic Outcome of Malpositioned Umbilical Venous Catheter

Abstract

A 265/7 weeks’, 985-g male infant was born to a 26-year-old mother with an unremarkable pregnancy until spontaneous rupture of membranes occurred 17 days before delivery. She had a bicornuate uterus, and her cervical culture result was positive for group B Streptococcus . The mother was admitted for monitoring of possible preterm labor and treatment of infection. Several biophysical profiles were performed, and results were consistently 10/10. After a course of antenatal corticosteroids and several days of penicillin, the mother developed uterine contractions for which she received magnesium sulfate and intravenous hydration. She was afebrile and had no uterine tenderness. The contractions stopped until the following morning when a complete blood cell count was performed. It was remarkable for an elevated white blood cell (WBC) count of 19,900/μL (19.9 × 109/L) with 33% bands. The contractions began again the next day, and the magnesium dose was increased. The fetal heart rate (HR) remained normal. The obstetrician retained by the plaintiff pointed out that delivery should have occurred at that time because the leukocytosis and contractions resistant to tocolysis signaled a strong probability of occult chorioamnionitis. The treating obstetrician said that he did not know the results of the elevated WBC until the following morning at 7 am, to which the plaintiff obstetrician retorted that he should have known within hours when the result became available and acted on that data. The following morning, even after the results of the WBC count were acknowledged, plans for delivery were still not made. The treating perinatologist stated in his deposition that delivery should have been undertaken the day before, and when he was contacted that following morning, he recommended to the treating obstetrician that delivery should be undertaken immediately because the mother might have occult chorioamnionitis. The …