A fetus requires a continuous supply of blood to receive the necessary nutrients and oxygen. When a pregnant woman has significant vaginal bleeding late in her pregnancy, there is a danger that it is due to placental abruption, a condition in which the placenta separates prematurely from the woman’s uterus, causing the tearing of the blood vessels in the area and the deprivation of the oxygen needed by the fetus.
As such, medical professionals must properly determine the cause of the bleeding and its impact on the fetus. When the bleeding is accompanied in addition to an abnormal fetal heart rate, an emergency caesarean section may be necessary. If this does not happen, the baby can be severely disabled for life or possibly even die. Consider, for example, the following reported case.
At the 39th week of pregnancy, an expectant mother felt a stream of colorless liquid coming out of her, and she went to the hospital. Once at the hospital, her staff examined her and fitted her with a fetal heart rate monitor. Approximately 7 1/2 hours after admission she experienced a burst of blood from her vagina. In fact, the doctor in charge of her care noted that the blood was bright red. Upon reviewing the fetal heart rate monitor, the doctor found that it was non-reactive, but rather than switch to an internal monitor to more accurately determine the fetal heart rate, the doctor decided to simply continue to monitor her progress. An ultrasound could not reveal the cause of the bleeding. And instead of appreciating the importance of bleeding as a sign of placental abruption, the doctor concluded that it was simply a sign of advancing labor.
Within 45 minutes, the staff observed decelerations in the fetal heart rate. After another 10 minutes, the monitor strips were suspected of worsening fetal distress. Instead of checking the fetal scalp pH to better determine the condition of the fetus or simply performing an emergency C-section, the physician and staff again continued the observation period. After another 10 minutes, a nurse observed a slowing of the fetal heart rate down to 50. It was only at this point that they attempted their first intervention by repositioning the mother and starting her on oxygen. Then the mother-to-be experienced another wave of bleeding, and the fetal heart rate monitor showed continued decelerations. Even with these ominous signs, it took another five minutes for the nurse to call the doctor. Despite the presence of these issues, no further action was taken at this point.
Twenty more minutes passed, and now there was another wave of bleeding. The fetal heart rate monitor by then indicated medium to minimal variability. Within half an hour, despite the presence of bleeding, the woman received an epidural. After about 40 more minutes, the first doctor was replaced by another. And still no action was taken despite the fact that the fetal heart rate continued to decelerate with a late component and the woman continued to bleed. The baby was finally delivered vaginally just over two hours later.
At birth, the baby had difficulty breathing and showed a mild to moderate response. Cord blood pH was recorded as acid. In addition, the amniotic fluid contained meconium. These are all signs that the baby had been in danger. A pediatric specialist was consulted and after finding that the baby had suffered from oxygen deprivation, the baby was intubated. In fact, the delay in the baby’s birth led to a prolonged period of oxygen deprivation which, in turn, led to severe neurological damage. At five years of age, the baby had a significant disability. He couldn’t crawl or sit up without help. He was legally blind. He suffered kidney damage and required a transplant. And he showed cognitive delays.
The parents filed suit on behalf of the baby, naming the two doctors and nurses as defendants. The law firm that represented the family was able to report that they reached a settlement in the amount of $1.2 million on behalf of the family.
As this case shows, a child can suffer devastating permanent injuries if placental abruption occurs while the mother is in labor and the doctors and nurses in charge of her care do not take immediate action. Although in this case the staff performed an ultrasound that did not reveal the presence of placental abruption, no effort was made to determine the source of the bleeding and worrisome changes in fetal heart rate. It is almost as if once the initial signs were ruled out, the medical staff locked into a single perspective from which all subsequent developments were interpreted. As a result, everything that happened was seen as part of a normal work process. In a medical situation, fixating on a particular interpretation can, as in the case discussed above, lead to a tragic outcome.