A 36 year old married woman became pregnant for the 3rd time in 2017. She had had two prior pregnancy fetal losses. Her age and that history put her at higher risk for another fetal loss. However, she started her prenatal care early, had a cerclage to strengthen the cervix to help prevent premature delivery, maintained a good diet, and diligently made all of her prenatal appointments. All evaluations of the fetus during her prenatal care were normal and reassuring.
She was admitted to the hospital's labor unit on Christmas day in early labor. Holiday hospital care is notorious for understaffing and, at times, poor care and poor outcomes.
During the course of her labor in the hospital over the next 12 hours, she developed uterine tachysystole, meaning more than 5 contractions in a 10 minute period. Each contraction causes a brief diminishment in fetal blood and oxygen circulation. Excessive uterine contractions, such as here, can be treated by a course of Terbutaline, a medication which can quickly reduce the frequency of those contractions.
That was successfully done here but another round was later needed but never given despite the nurses repeatedly asking the busy physician to do so.
As a result, tachysystole resumed. Meanwhile other abnormalities arose. After about 6 hours of labor the fetus developed an elevated heart rate (tachycardia) and the mother started showing signs of infection: shivering, shaking, high temperature, and her own maternal tachycardia.
The nurse reported to the physician these worrisome abnormalities, and the fetus' evolving distress. The nurse asked the physician to permit better fetal assessment by using a fetal scalp electrode (a monitoring device placed on the fetal scalp from the vagina) but was refused. She also asked that more terbutaline be given to decrease the frequency of uterine contractions and stress on the fetus. The fetus was eventually delivered vaginally but was asphyxiated (lack of oxygen). She was cooled (a treatment in which a cooling cap is placed on the baby’s head in hopes of reducing the swelling in the brain caused by the lack of oxygen) for presumed HIE (hypoxic ischemic encephalopathy). In spite of this treatment, the baby developed a seizure disorder. The brain MRI showed an acute severe asphyxial injury. Today this 3 year old toddler has cerebral palsy, is delayed in all development, has a small head, can understand some words but cannot express herself. She receives 24 hour at home care by her family.
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