Legal Briefs: Did Vacuum Extraction Use Cause Brain Injury?

Abstract

* Abbreviations: CT, : computed tomography IVH, : intraventricular hemorrhage MRI, : magnetic resonance imaging A 33 4/7 weeks’ gestation, 1,900-g female infant was born to a 21-year-old mother whose pregnancy was complicated by hypertension. The mother was admitted to the hospital and given magnesium sulfate 5 days before delivery. After a course of antenatal corticosteroids, the obstetrician induced labor because of worsening hypertension. Spontaneous rupture of membranes occurred 4 hours after oxytocin was started. Variable decelerations occurred, for which the obstetrician ordered an amnioinfusion. The obstetrician retained by the plaintiff was critical of the amnioinfusion, stating that the salt load given to the mother during this procedure was contraindicated because of the mother's hypertension. Nine hours after oxytocin was started, when the cervix was completely dilated, the mother had 2 brief seizures. The fetal heart tracings were normal during the seizures. Ten minutes later, the obstetrician placed a vacuum device on the fetus and delivered the infant. The plaintiff's obstetrical expert pointed out that the literature and the manufacturer's guideline state that a fetus of less than 34 weeks’ gestation should not have a vacuum-assisted delivery. The treating and defense obstetrician said that the vacuum extraction was warranted because of the mother's seizures. The Apgar scores were 8, 9, and 9 at 1, 5, and 10 minutes, respectively. The infant's physical examination showed molding, cephalohematoma, facial bruising, retinal hemorrhage, a normal head circumference of 32 cm, and a low blood pressure of 53/21 mm Hg with a mean of 31 mm Hg, for which a 20-mL bolus of normal saline was given. The initial hematocrit was 63.9%. The magnesium level was 3.8 mEq/L (1.9 mmol/L). The infant began having more apnea and required intubation at 9 hours because of increasing severity of apnea. The treating and defense neonatologist said the apnea was secondary to the magnesium and/or apnea of prematurity. The plaintiff neonatologist said …