Legal Briefs: Head and Shoulder Trauma

Abstract

A 4,580-g, 38 5/7 weeks’ gestation male infant was delivered by a 33-year-old gravida 5, para 1, aborta 1 woman whose pregnancy had been unremarkable. One month before delivery, the woman reported a decrease in fetal movement, but fetal activity resumed subsequently and the nonstress test result was normal. The pregnancy continued without problems. However, when labor began and the fetus did not descend, she received oxytocin to augment labor. Fetal tachycardia, decreased variability, and excessive uterine activity were noted. Also, inadequate rest time between contractions appeared as the second stage of labor was approaching. The plaintiff obstetrician pointed out that the fetus was being stressed since the peak of 1 contraction to the next peak should be at least 2 minutes, and the end of 1 contraction to the beginning of the next should be at least 1 minute. He also discussed that oxytocin should have been discontinued because of the lack of descent and the excessive uterine activity. The obstetrician retained by the defense said that technically tachysystole was not present and the tracing was category 2. He stated that the continuation of oxytocin was acceptable because the fetus was not descending adequately. The plaintiff obstetrician maintained that the tracings were concerning; the progression of labor was not appropriate; and it was clear, hours before delivery, that the pregnant woman could not safely deliver this fetus vaginally. Two and a half hours before delivery when the station was −1 and the cervix was fully effaced and dilated, the membranes were artificially ruptured. Thin, light brown, meconium-stained fluid was noted. The defense obstetrician said that the decreased fetal movement that had …