Pregnancy and childbirth are supposed to be joyous occasions, filled with anticipation and excitement. However, when negligence occurs during the labor and delivery process, the consequences can be devastating.
A 38-week pregnant mother in her 30s eagerly awaited the arrival of her healthy baby boy. Let's call the mother Christie and the baby Brandon.
Christie experienced a stable pregnancy, and her obstetrician (OB) reassured her that she was on track to have a smooth delivery. To ensure everything would go well, Christie promptly headed to a Houston hospital as soon as she noticed her water break, so she could be monitored under the professional care of a trained medical staff.
Everything continued to look good up until her 16th hour of labor when Christie developed a fever and the baby showed signs of fetal tachycardia (high heart rate) on the electronic fetal monitoring strip. What should you do if you have a fever or pain during pregnancy?
Shortly thereafter, the labor and delivery nurses began monitoring Christie's temperature mostly by measuring axillary temperatures (in the armpit) rather than oral temperatures. This detail is significant because axillary temperatures are often one degree lower than oral temperatures. One degree may not seem consequential, but that difference in temperature can be a determining factor in where the mom had a fever that requires urgent medical treatment.
Christie's increases in temperature should have been glaring red flags for the nursing staff to start more intensive treatment; nevertheless, they did not notify the obstetrician, who happened to be off-site. The significance of fever during labor and delivery as a cause of brain injury cannot be overstated.
During delivery, there were some complications. Brandon's umbilical cord was wrapped around his neck once, which restricted his breathing, and he experienced mild shoulder dystocia that was resolved in less than a minute. Shoulder dystocia occurs when one or both of the baby's shoulders become lodged in the birth canal; this poses serious challenges for delivery. At birth, Brandon was limp and had respiratory distress and hypotonia—a condition characterized by weak muscle tone.
At this point, the nurses knew urgent measures were necessary, so they transferred Brandon to the Neonatal Intensive Care Unit (NICU). There was a significant delay over four hours to get antibiotics started after delivery. The NICU nurses reported that Brandon had two seizure-like events. This is when the attending medical staff recognized that Christie's fever caused chorioamnionitis, which ended up seriously impacting her baby's health.
What is chorioamnionitis and how does it affect the baby?
Chorioamnionitis is an infection of the amniotic fluid and placenta within the uterus. Women may develop chorioamnionitis when the amniotic sac ruptures and exposes the baby to bacteria for an extended time before birth. This vulnerable period allows bacteria from the external organ to travel up into the uterus, leading to the infection of the amniotic fluid.
This is one of the reasons why most obstetricians went to deliver the baby within 24 hours of ruptured membranes or water breaking. In Christie's case, she didn't delivery her baby until around 27 hours after her water broke.
The infection itself compromises the baby's oxygen intake, and the uterus's inflammatory response to the infection puts additional pressure on the baby. Prolonged exposure to this acidotic state dramatically increases the risk of suffering from further injuries. Potential injuries include cerebral palsy, hypoxic-ischemic encephalopathy (HIE), meningitis, brain damage, and even death.
How is chorioamnionitis treated?
Although chorioamnionitis is extremely dangerous, it is treatable with intravenous (IV) antibiotics if the nurses pay close attention and notify the doctor to get fast medication orders. Nurses should recognize the common symptoms, which include maternal fever, fetal tachycardia, and foul-smelling amniotic fluid.
By no means is this complication the mother's fault. Expecting women go to the hospital to be professionally monitored by people who are trained to deal with adverse labor and delivery events. The women are doing their part, so the nurses must also be held accountable to fulfill their part.
How can chorioamnionitis cause hypoxic-ischemic encephalopathy (HIE)?
HIE is a degree of permanent brain damage caused by the limited supply of oxygen and blood going to the baby's brain during the labor and delivery process. Because chorioamnionitis is a maternal complication that severely affects the baby's oxygen levels, it is an independent cause of HIE.
Symptoms are hypotonia (weak muscle tone), respiratory issues (trouble breathing), hypoxia, anoxia, reduced heart rate, and high acidity in blood work.
Unfortunately, the labor and delivery team's failure to aptly recognize and treat chorioamnionitis led to the development of HIE and permanent brain injury to Brandon.
Our medical and nursing experts contend that if the nurses recorded oral temperatures, instead of axillary temperatures, and reported the maternal fever and fetal tachycardia to the obstetrician, they would have been able to properly diagnose and adhere to the standard of care for chorioamnionitis, which is to treat immediately with antibiotics.
If they had started Christie on IV antibiotics as soon as her fever developed, she and her baby would have already had four hours of treatment, so most of the damages would likely have been avoided. What's the standard of care and why does it matter in a Texas medical malpractice case? .
The case study of Christie and Brandon serves as a stark reminder of the devastating consequences that negligence during childbirth can have on both the mother and baby. This failure to address chorioamnionitis and its link to HIE emphasizes the importance of prompt recognition and treatment of maternal and fetal complications.
If your baby has been seriously injured by poor hospital or labor and delivery care in Texas, contact a top-rated experienced Texas medical malpractice birth injury lawyer for a free consultation about your potential case. Discover how to pick the right Texas attorney for your HIE or birth injury medical malpractice case.
* Katherine Painter, a Painter Law Firm summer 2023 intern, helped in the research and preparation of this article.
