Delay in C-Section Produces Severe Birth Complications

The Case

A 26-year-old female arrived at the hospital for delivery of her first child by induction. The pregnancy was largely unremarkable, labs were normal (including Strep B), and the patient had three normal ultrasounds. The last ultrasound was performed one week before delivery and showed excessive maternal weight gain and growth at 88%. At approximately 1:30 p.m., the doctor’s progress note ordered Pitocin and stated that there was good fetal movement and that vaginal delivery was expected.

At 2:00 p.m., the nurse paged the doctor because Category III tracings showing prolonged fetal heart decelerations. The patient was moved to her left side and given oxygen by mask. The IV and the Pitocin were both stopped. The doctor attempted vacuum extraction for more than an hour, but the baby was delivered flaccid. His APGAR scores were 2, 4, and 4 and the head-cooling protocol was initiated. The infant was later diagnosed with mild to moderate dyskinetic cerebral palsy. 

Risk Management Commentary & Advice

In this case, the physician failed to react in a timely way to the CAT3 strip and delayed ordering a C-section. The physician could have commenced an emergency C-section at least 50 minutes before the infant was actually delivered rather than continuing to proceed with the vacuum-assisted vaginal delivery (a process that likely had negative impacts on the infant). Physicians must follow the ACOG guidelines for assessment and management of EFM tracings and the required interventions for decelerations.

Costs associated with failure to perform a C-section: The average indemnity claim for failure to perform a C-section is $621,000.