Case Studies November 19-20, 2009 Medical Legal Issues in Obstetrics Practice Ronald S. Gibbs, MD Professor, Department of Obstetrics and Gynecology Associate Dean, Continuing Medical Education

Case Study 1 – Neonatal Brain Injury, Neonatal Encephalopathy and Cerebral Palsy A 27 year old primigravida was admitted to the hospital in spontaneous labor at 38 weeks gestation. Her pregnancy has been complicated by mild gestational hypertension. She also had a 2 day “viral” illness at 28 weeks, with symptoms of low grade fever and cough.

Case Study 1 (Cont’d) Fetal growth has been normal. There have been no other complications. The Group B Streptococcal culture was negative at 37 weeks. Her labor progressed normally through the first stage; an epidural was inserted at 5 centimeters. Her second stage of labor has become prolonged with arrest of fetal descent at +3 (of 5) station and a fetal position of right occiput anterior (ROA).

Case Study 1 (Cont’d) Category II fetal heart tracing has developed, and meconium has become evident. The obstetrician plans a low forceps delivery.

Case Study 2 – Shoulder dystocia A 35 year old woman, gravida 3 para 2, was admitted with spontaneous rupture of the membranes 12 hours ago, at 40 weeks gestation. She had two previous healthy infants, each by spontaneous vaginal delivery, with birth weights of 8# each (about 3700 grams). Her weight is 195 pounds, with a BMI of 30, but her blood sugar screen was normal.

Case Study 2 (Cont’d) The estimated fetal weight on admission is 8 pounds (3700 grams). There is no evidence of chorioamnionitis. On speculum exam, the cervix appears to be 2 centimeters dilated. An unengaged vertex is presenting. An induction of labor is begun.