Legal Briefs: Was the Adverse Outcome from Goldenhar Syndrome or Hypoxic-Ischemic Events?

Abstract

EDITOR’S NOTE The Legal Briefs feature is based on actual malpractice cases with opinions of the plaintiff and defense physician experts interspersed throughout the case. The format of this feature does not provide evidence that supports or refutes each of these opinions. A 3,765-g male infant was delivered at 37 weeks’ gestation to a 34-year-old gravida 1, para 0 woman with morbid obesity, chronic hepatitis B, and chronic hypertension. The woman’s prenatal course was benign and she was negative for group B Streptococcus . She was brought to the hospital because of spontaneous rupture of membranes and some irregular contractions. The obstetrician decided to ripen her cervix with misoprostol, followed by an induction with oxytocin. Nine hours after the initiation of oxytocin, her cervix was fully dilated and she began pushing. The fetus was in the occiput posterior position and despite pushing, remained at −2 to −1 station. With each push, a late deceleration appeared. The fetal heart tracings changed from category 1 to category 2. Tracings progressed to fetal tachycardia, lack of accelerations, minimal moderate variability, and late and variable decelerations. The plaintiff obstetrician was critical of the management. He pointed out that the combination of 1) the fetus being remote from a safe vaginal delivery, 2) the lack of descent despite the pushing, and 3) the fetal intolerance to labor, was an indication for a cesarean delivery. Forceps were attempted 3 times. The plaintiff obstetrician was critical of the use of forceps, stating that the intolerance to labor and the high station mandated discontinuation of the oxytocin and the need for an emergent cesarean section. When the forceps failed, the obstetrician …