A fetus requires a continuous supply of blood in order to receive the necessary nutrients and oxygen. When a pregnant woman has significant vaginal bleeding in the late stages of her pregnancy there is a danger that it is due to a placental abruption, a condition whereby the placenta separates prematurely from the woman's uterus, which results in the tearing of blood vessels in the area and the deprivation of necessary oxygen to the fetus.
As such, medical professionals need to properly determine the cause of the bleeding and its impact on the fetus. When the bleeding is also accompanied by an abnormal fetal heart rate it may be necessary to perform an emergency C-section. If this does not happen the baby may suffer severe lifelong disabilities or possibly even die. Consider, for example, the following reported case.
In the 39th week of pregnancy an expected mother felt a stream of colorless fluid leave her went to the hospital. Once at the hospital the staff examined her and placed a fetal heart rate monitor on her. Approximately 7 1/2 hours after her admission she experienced a burst of blood from her vagina. In fact, the doctor in charge of her care observed that the blood was colored bright red. When checking the fetal heart rate monitor the doctor found that it was not reactive but rather than switch to an internal monitor to more accurately determine the heart rate of the fetus the doctor instead decided simply to keep observing her progress. An ultrasound failed to reveal the cause of the bleeding. And rather than appreciate the significance of the bleeding as a sign of a placental abruption, the doctor concluded that it was simply a sign of advancing labor.
Within 45 minutes the staff observed decelerations in the heart rate of the fetus. After another 10 minutes the monitor strips were suspicious for worsening fetal distress. Rather then checking the pH of the fetus's scalp in order to better determine the condition of the fetus or simply perform an emergency C-section the doctor and staff again continued the period of observation. After yet another 10 minutes a nurse observed a fetal heart rate deceleration down to 50. It was only at this point that they attempted their first intervention by repositioning the mother and commencing oxygen. The expectant mother then experienced another wave of bleeding and the fetal heart rate monitor showed continuing decelerations. Even with these ominous signs the nurse took yet another five minutes before calling the doctor. Despite the presence of these issues no additional measures were taken at this point.
Twenty additional minutes went by and now another wave of bleeding occurred. The fetal heart rate monitor by then was indicating average to minimal variability. Within a half-hour, despite the presence of the bleeding, the woman was placed on an epidural. After approximately 40 more minutes the first doctor was replaced by another. And still no measures were taken even though the fetal heart rate continued to include decelerations 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 little to moderate response. The cord's blood pH registered as acidic. In addition, the amniotic fluid contained meconium. These are all signs that the baby had been in distress. A pediatric specialist was consulted and after finding that the baby had suffered from oxygen deprivation the baby was intubated. Indeed, the delay in delivering the baby led to a prolonged period of oxygen deprivation which in turn caused severe neurological injuries. At five years of age the baby had a significant disability. He was unable to crawl or even to sit without assistance. He was legally blind. He suffered kidney damage and required a transplant. And he showed cognitive delays.
The parents brought a lawsuit on behalf of the baby naming the two doctors and the nurses as defendants. The law firm that represented the family was able to report that they achieve a settlement in the sum of $1.2 million on behalf of the family.
As this case shows a child can suffer devastating permanent injuries if a 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 which did not reveal the presence of the placental abruption, no effort was made to determine the source of the bleeding and the worrisome changes in the fetal heart rate. It is almost as though once the initial signs were discounted the medical staff was locked into a single perspective from which all subsequent developments were interpreted. As a result everything that happened was viewed as being part of a normal labor process. In a medical situation becoming fixed on a particular interpretation can, as in the case examined above, lead to a tragic outcome.
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