Abnormal fundal height: Mishandled?

Undisclosed County (Calif)

A woman at 36.5 weeks’ gestation presented to a clinic for prenatal care. At that time, her fundal height was noted as 31 cm—a 4-cm decline from her previous measurement.

Over the remainder of her pregnancy, her fundal heights were as follows:

• 31 cm at 37.5 weeks’ gestation—however, a different clinician measured 38 cm at that same visit
  
• 32 cm at 39 weeks, 2 days
  
• 32 cm at 40 weeks, 2 days (good fetal heart tones and fetal movement were noted)
  

At 41 weeks, 1 day, the woman presented to the hospital with labor pains. The fetal monitoring strips showed severe variable decelerations and fetal tachycardia with a baseline of 170. A vaginal exam showed 3-cm dilation, 90% effacement, and the fetal vertex at 0 station. The physician ordered internal monitors, amnioinfusion, and terbutaline administration.

Roughly 30 minutes after the drug was given, the child was delivered by cesarean section. He weighed approximately 5 lb and had Apgar scores of 3 and 6. Thick meconium was noted. Two months later, the child was diagnosed with cerebral palsy consistent with hypoxic or ischemic insult.

The plaintiff claimed the defense was negligent in failing to diagnose intrauterine growth retardation.

The defense maintained the standard of care was met at all times.

• The case settled for $4.1 million at mediation.
  

The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.

Undisclosed County (Calif)

A woman at 36.5 weeks’ gestation presented to a clinic for prenatal care. At that time, her fundal height was noted as 31 cm—a 4-cm decline from her previous measurement.

Over the remainder of her pregnancy, her fundal heights were as follows:

• 31 cm at 37.5 weeks’ gestation—however, a different clinician measured 38 cm at that same visit
  
• 32 cm at 39 weeks, 2 days
  
• 32 cm at 40 weeks, 2 days (good fetal heart tones and fetal movement were noted)
  

At 41 weeks, 1 day, the woman presented to the hospital with labor pains. The fetal monitoring strips showed severe variable decelerations and fetal tachycardia with a baseline of 170. A vaginal exam showed 3-cm dilation, 90% effacement, and the fetal vertex at 0 station. The physician ordered internal monitors, amnioinfusion, and terbutaline administration.

Roughly 30 minutes after the drug was given, the child was delivered by cesarean section. He weighed approximately 5 lb and had Apgar scores of 3 and 6. Thick meconium was noted. Two months later, the child was diagnosed with cerebral palsy consistent with hypoxic or ischemic insult.

The plaintiff claimed the defense was negligent in failing to diagnose intrauterine growth retardation.

The defense maintained the standard of care was met at all times.

• The case settled for $4.1 million at mediation.
  

The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.

Undisclosed County (Calif)

A woman at 36.5 weeks’ gestation presented to a clinic for prenatal care. At that time, her fundal height was noted as 31 cm—a 4-cm decline from her previous measurement.

Over the remainder of her pregnancy, her fundal heights were as follows:

• 31 cm at 37.5 weeks’ gestation—however, a different clinician measured 38 cm at that same visit
  
• 32 cm at 39 weeks, 2 days
  
• 32 cm at 40 weeks, 2 days (good fetal heart tones and fetal movement were noted)
  

At 41 weeks, 1 day, the woman presented to the hospital with labor pains. The fetal monitoring strips showed severe variable decelerations and fetal tachycardia with a baseline of 170. A vaginal exam showed 3-cm dilation, 90% effacement, and the fetal vertex at 0 station. The physician ordered internal monitors, amnioinfusion, and terbutaline administration.

Roughly 30 minutes after the drug was given, the child was delivered by cesarean section. He weighed approximately 5 lb and had Apgar scores of 3 and 6. Thick meconium was noted. Two months later, the child was diagnosed with cerebral palsy consistent with hypoxic or ischemic insult.

The plaintiff claimed the defense was negligent in failing to diagnose intrauterine growth retardation.

The defense maintained the standard of care was met at all times.

• The case settled for $4.1 million at mediation.
  

The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn (www.verdictslaska.com). While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.