Defense Verdict Obtained in Cord Prolapse Case

Dustin J. Denning, with assistance from Jared T. Hiatt, successfully defended our hospital client in a very sad and emotional medical malpractice jury trial in which the parents of a deceased newborn alleged that the hospital’s labor and delivery nurse was negligent for allowing the laboring mother, whose membranes had ruptured at home prior to coming to the hospital, to get out of bed before the fetal head was engaged at zero station, and negligent for failing to educate the mother on the risks of a cord prolapse developing if she got out of bed.  The laboring mother was permitted to get out of bed when the nurse determined that the fetal head was vertex, it was well applied to the cervix and not ballotable, and fetal heart tones were reassuring.  The fetal heart tones continued to be monitored by a portable telemonitor that allows laboring mothers to get out of bed and ambulate around the room.

Plaintiffs argued that allowing the mother to ambulate around the room and/or sit in a chair at bedside caused the umbilical cord to develop into what is called an occult, or hidden, cord prolapse.  It was not an overt cord prolapse that comes through the cervix.  The cord likely occluded as it lay astride the baby’s head but was not detectable by the nurse when performing cervix examinations.  Fetal heart tones were normal and reassuring upon admission to the labor and delivery unit, and remained reassuring for over 2 hours until heart tones began suddenly decreasing.  After attempting nursing interventions for about 8-9 minutes and repeatedly adjusting the fetal heart rate monitor to no avail, the nurse timely contacted the on-call physician once hearts tones were confirmed to be bradycardic.  The baby was delivered emergently by c-section within 37 minutes of the start of the decrease in fetal heart tones (and within 14 minutes of the attending physician’s decision to proceed to an emergent c-section), but the baby was limp and had no respiratory effort at birth.  Resuscitation efforts were unsuccessful.  The plaintiffs’ attorney asked the jury to award them $3,000,000 during closing arguments.

Plaintiffs’ experts argued that a laboring mother should never be allowed out of bed for any reason until the fetal head reaches station zero.  We defended the case by showing that the standard of care testimony offered by plaintiffs’ OBGYN and nurse experts was not supported by anything in the world’s literature, including ACOG and AWHONN.  We pointed to literature from ACOG and AWHONN stating that ambulation should be encouraged as it helps speed the process of labor, reduces the need for a c-section, and lying in a bed can cause risk to both the mom and baby.  We demonstrated that there were no contraindications for the mother to get out of bed, and the risk of a cord prolapse was minimized because the fetal head was well applied to the cervix and not ballotable. We argued that while the outcome was certainly tragic, it was not due to anyone’s fault.  We focused a good portion of jury selection on the issue of sympathy and empathy.  We told the jury panel at the outset that the case involved the death of a newborn which allowed us to identify jurors who would potentially be overcome by emotion and therefore unable to judge our client fairly and based solely on the medical evidence.

After a five-day jury trial, a Saline County, Kansas, jury agreed and returned a verdict in favor of our hospital client after deliberating for about 1 hour.