There are risks to stopping fetal monitoring before delivery

This morning at the deposition of the labor and delivery nurse who used to work at a hospital in Cypress, Harris County, Texas. We discussed how she came on duty right at a critical time in our client’s labor and delivery of her twin pregnancy.

The mom’s membranes prematurely ruptured (her water broke) earlier in the afternoon and she went to the hospital for evaluation after contacting her obstetrician (OB/GYN). For over six weeks, the mom had a delivery plan in place with her obstetrician for a cesarean section (C-section) delivery of her twins. This nurse came on duty around 7:00 p.m.

At deposition, the nurse admitted that the patient had a high-risk pregnancy because she was carrying twins. Yet, in the hours preceding her shift, her labor and delivery nursing colleagues ignored a concerning uterine contraction pattern called tachysystole.

Tachysystole is generally a condition where the mom’s uterus is contracting too frequently to allow periods of rest in between contractions. Over time, tachysystole can cause injury to an unborn baby (fetus) by oxygen deprivation, or hypoxia.

Shortly after this nurse came on duty, though, there was another concerning finding. The electronic fetal monitoring showed that the fetal heart rates were plummeting after contractions. These are called late decelerations, and constitute a medical emergency because they are a sign of reduced blood flow to the placenta. Without urgent delivery, the diminished blood flow to the placenta can cause fetal hypoxia and permanent brain injury.

The record-keeping in the hospital’s chart is terrible during this important time period. From the depositions of the obstetrician and labor and delivery nurse, though, we can tell that the healthcare team recognized the significance of the late decelerations and moved the mom to the operating room for C-section delivery.

Shortly before moving the mom to the operating room just across the hallway, someone disconnected the electronic fetal monitor. In the operating room, someone used Doppler equipment to assess the fetal heart tones for a few seconds. I said “someone” in both of the preceding sentences because the medical record doesn’t identify who did these things.

The anesthesiologist, in fact, is the only person who even mentioned the Doppler, and the hospital maintained no data from it. For nearly 30 minutes in the operating room, the nursing staff conducted no fetal monitoring. The first twin was born without any complication, but unfortunately the second twin was delivered a minute later and was discovered to have a permanent brain injury.

With adequate fetal monitoring in the operating room, our experts believe that an earlier delivery would have occurred, that would have preserved a safe intrauterine environment that would’ve avoided the second twin developing brain injury. Even when there’s a decision to proceed with the C-section and the patient is in the operating room, the obstetrician and medical and delivery team can move in an expedited fashion, including choice of anesthesia, or the slower pace.

In high-risk pregnancies, higher levels of fetal monitoring are warranted and when there is a sign of fetal distress, so is urgent delivery.

If your baby has sustained a serious injury because obstetrical or labor and delivery errors, then contact a top-rated experienced medical malpractice lawyer for free consultation about your potential case.

Robert Painter
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Robert Painter

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm Medical Malpractice Attorneys in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him for a free consultation and strategy session by calling 281-580-8800 or emailing him right now.