Case Studies - Colorado Bar Association

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
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
An induction of labor is begun.