Newborn Brain Injury Due to Delayed Delivery – September 13, 2023
On September 13, 2023, WVFK&N attorneys Brian Cathell and Brendon Stern filed a medical malpractice claim on behalf of a newborn who suffered an avoidable brain injury.
The complaint alleges that on December 21, 2017, the mother presented to the University of Maryland Medical Center (“UMMC”) emergency department with complaints of pelvic cramping, intermittent vaginal bleeding, nausea, and vomiting since December 17, 2021. An ultrasonography of the pelvis was performed and revealed that the mother was 7 weeks pregnant with dichorionic-diamniotic twins. She was ultimately discharged without any major treatment. This marked the mother’s third pregnancy.
The mother then established prenatal care within the University of Maryland Medical System (“UMMS”). At a prenatal appointment on January 18, 2018, the mother discussed with her providers her history of cervical insufficiency (her first term pregnancy required a McDonald cerclage for a cervical insufficiency of 12 millimeters at 19 weeks). Despite this, there was no discussion at this appointment regarding cervical surveillance or a cerclage.
During a prenatal appointment on January 29, 2018, one of the mother’s providers recommended that the mother undergo serial cervical length measurements starting less than 4 weeks from the time of that appointment.
On February 10, 2018, the mother presented to the UMMC labor and delivery department with complaints of intense vaginal pain. The mother discussed her history of cerclage and cervical with her providers during this visit, and she was discharged home with preterm labor precautions, but there was no discussion about cervical surveillance or a cerclage moving forward.
On February 15, 2018, the mother had another prenatal visit. At this appointment, her provider again reviewed the mother’s history of cerclage and cervical insufficiency. Still, there was no discussion regarding cervical surveillance or a cerclage. On February 22, 2018, the mother’s cervix was found to be normal and closed, measuring 46 millimeters.
On March 19, 2018, the mother’s cervix was found to be normal and closed, measuring 55 millimeters. On March 22, 2018, at this appointment, the mother reported good fetal movement, and her provider reviewed the mother’s history of cerclage and cervical insufficiency, but there was again no discussion regarding cervical surveillance or a cerclage.
On April 7, 2019, the mother went to UMMC and was found to be a half-centimeter dilated. No cervical length was recorded at this visit. When the mother had a prenatal appointment on April 16, 2018, it was apparent that the cervix had shortened, there was cervical funneling, and there was no measurable closed portion of the cervix, so she was sent to UMMC’s labor and delivery department, where it was revealed that she was 3 centimeters dilated, was 25% effaced, and had no measurable cervix. She remained at the labor and delivery department until her twins were delivered.
On April 22, 2018, there were concerns about advancing preterm labor, and the mother’s cervical dilation changed from 3 cm to 5 cm. There was also a concern of ascending chorioamnionitis in the setting of advancing preterm labor due to fetal tachycardia of one of the fetuses, maternal tachycardia, elevating white blood count, and c-reactive protein. As such, it was recommended by a provider to proceed with delivery, specifically a cesarean delivery due to fetuses in vertex/breech presentation.
The twins were delivered by cesarean section at 24 weeks and 4 days gestation. Twin A weighed 660 grams and had Apgar scores of 2 at 1 minute, 5 at 5 minutes, and 6 at 10 minutes. Twin B weighed 680 grams and had Apgar scores of 1 at 1 minute, 1 at 5 minutes, and 2 at 10 minutes. Labs revealed Twin A fetal membranes with acute chorioamnionitis and Twin B fetal membranes with marked acute chorioamnionitis. Both infants were resuscitated, intubated, and given 3 doses of surfactant. The twins required mechanical ventilation to assist with breathing, and they were transferred to the NICU after being intubated. Twin B passed away after spending a week in the NICU.
Twin A’s NICU course lasted approximately 5 months. A head ultrasound taken on April 23, 2018, showed a new grade 1 germinal matrix hemorrhage (this progressed to a grade 2 on May 7, 2018), a small right cerebellar intraparenchymal hematoma, and an ill-defined echogenic area in the white matter of the right frontoparietal region. Twin A developed retinopathy of prematurity by July 10, 2018.
Today, Twin A suffers from permanent and severe brain injury, pulmonary injury, cardiac issues, motor function delays and deficits, intellectual disabilities, behavioral issues, inability to care for herself or perform the activities of daily living, global developmental delays, and other injuries and damages arising from her extremely premature birth that would have been avoided had the defendant providers complied with the standard of care.
The lawsuit alleges that the injuries were a result of the negligence of the University of Maryland Medical System and its employees in failing to appreciate and timely recognize clinical signs and symptoms of a shortened cervix and failing to make efforts to stop, slow, or delay preterm labor (i.e., offering to place a cerclage).
The action is pending in the Circuit Court for Baltimore City in the State of Maryland.
