BIRTH INJURY Medical Malpractice Lawsuit: Excessive Traction Results in Permanent Brachial Plexus Injury.
The mothers prenatal care included a one-hour GTT which was abnormal, and she was diagnosed with gestational diabetes. Her pregravid weight was approximately 280 pounds. The mother inquired about her mode of delivery and was informed about indications, risks and benefits of induction, vaginal delivery, the possibility of shoulder dystocia. Despite that the mother was not offered a cesarean section nor did she ever decline a cesarean section to avoid shoulder dystocia. Had the mother been offered a cesarean section to avoid shoulder dystocia and fetal injury, she would have opted for this mode of delivery.
Three weeks prior to delivery the baby underwent an ultrasound that suggested an estimated fetal weight by ultrasound to be 8lb 8oz, or 3,857 grams. Three weeks later the mother presented to the hospital in active labor. Her pregnancy had been complicated by morbid obesity and gestational diabetes/possible insulin-dependent type 2 diabetes.
At the time of admission, clinical examination of the mother by the doctor suggested an estimated of fetal weight of 7 lbs. This was obviously incorrect as it was smaller than the EFW of three weeks earlier.
At delivery the doctor documented that the head spontaneously rotated to the left occiput anterior position and was at +2 station, at which point, she advised the patient of the need to expedite delivery and offered a vacuum assistance. The doctor documented that mother demonstrated poor pushing effort and that there were inconsistent fetal heart tracings due to patient’s weight.
The Plaintiffs alleged that the doctor rushed the delivery by not allowing the fetus time to continue to descend and rotate through the mother’s pelvis. Also, that there was no need to consider a vacuum delivery but that once considered, the option of a cesarean section and the option of vacuum delivery should have been offered to the parents. The plaintiffs alleged that the doctor failed to a comply with the standard of care by failing to anticipate and prepare for the possibility of shoulder dystocia occurring.
The plaintiffs also alleged that the doctor further breached the standard of care when she failed to inform the parents of the increased risks to the baby associated with vacuum delivery in general, and particularly when utilized in a patient the doctor already suspected as being at risk for shoulder dystocia.
The evidence showed that based upon the medical record with a subsequent contraction, traction was placed. The father was at the bedside and testified at trial at delivery he saw the doctor grasp at his son’s head on both sides and pull in a downward lateral direction pulling and twisting the baby’s head. Also, that the doctor was using tremendous force and that he thought the doctor could break the infant’s neck prior to delivery of the infant.
The plaintiff’ s alleged that the doctor breached the standard of care by applying inappropriate or excessive traction in the presence of shoulder dystocia. The standard of care calls for cessation of maternal pushing, examination of the posterior pelvis, and avoidance of any traction after diagnosis of shoulder dystocia and until the shoulder dystocia is relieved by properly applied maneuvers. The evidence showed that the doctor breached the standard of care by allowing the mother to continue with her pushing efforts and by failing to refrain from traction after diagnosis of shoulder dystocia. Inappropriate traction separates the baby’s head away from shoulder. Traction that involves forceful twisting and pulling of the baby’s head is below the standard of care and is a known and well-accepted cause of this child’s permanent brachial plexus injury.
At delivery the baby weighed 9 lbs., 1 ounce and had Apgars of 4, 8 and 8. Upon discharge from the hospital, the baby was noted to have suffered a shoulder dystocia with right Erb’s palsy.
The child suffered a global brachial plexus nerve injury involving all five nerves of the brachial plexus. A global injury to the brachial plexus results from “excessive” traction during delivery.
The infant subsequently underwent brachial plexus decompression with clavicular osteotomy, excision of neuroma at C5 and C6 avulsion injuries as well as involving the upper trunk and divisions, spinal accessory direct nerve transfer to the suprascapular nerve with utilization of 9-0 epineural suture, microscope and fibrin glue, T2, T3 and T4 intercoastal motor branch nerve transfers to musculocutaneous motor branches for biceps and brachialis, end to side repair upper trunk end to side to C7 nerve root; lower trunk T1 injury end to side to C8 and remainder of the lower trunk and application of sling with swath. Eleven months later, the child had a second surgery.
Despite two surgeries the child has had no biceps function. Further, he does not have full supination of his arm, and his shoulder function is limited. The child is left with a permanent brachial plexus injury.
After a trial, the Plaintiffs were awarded One Million Six Hundred Thousand ($1,600,000.00) Dollars.