Decision To Pursue Natural Childbirth Leaves Infant With Brain Damage

This case involves a patient that had a high-risk pregnancy. The patient’s physician knew that the fetus had the umbilical cord surrounding the cervical spine and that the nuchal cord was a concern. Rather than scheduling a caesarian section to remove the fetus earlier, the physician elected to proceed with natural birth. The baby was partially born with the nuchal cord wrapped very tightly around her neck such that it had to be cut to complete the delivery. Immediately upon birth, the baby suffered seizures, hypoxic encephalopathy, and respiratory distress syndrome.

Question(s) For Expert Witness

1. How often do you see patients who are high-risk pregnancies with ultrasounds showing the umbilical cord and/or nuchal cord are wrapped around the cervical spine?

2. What are the indications for a caesarian section versus a natural birth in a high-risk pregnancy?

Expert Witness Response E-147332

Nuchal cords complications are common and occur in up to 30% of pregnancies. These problems are often seen in imaging. Tight nuchal cords have been associated with bad outcomes, including fetal demise and fetal asphysia. Type B nuchal cords that hitch around the baby's neck are more likely to be associated with a bad outcome. Antenatal testing with biophysical profiles and NSTs can be done. Nuchal cords can be associated with category 2 and 3 fetal heart tracings in labor. The fetal heart tones during labor decides who labors and who gets sectioned. I have the same 30% cesarean rate as every other OBGYN in my state of practice. Indications for cesarean include non reassuring fetal status, failure to progress and failure to descend. I have been on PIOC committees and reviewed similar cases.