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Case Example: Delayed Delivery of Twin “B”

Posted on September 23, 2012

A minor plaintiff’s mother was admitted to the hospital at approximately thirty weeks gestation with a twin pregnancy for continuous monitoring and possible induction of labor. Three days later, she went into active labor and an ultrasound revealed "Twin A" to be vertex and "Twin B" to be breach.

Despite this information, the mother was never informed that she could have a c-section instead of a vaginal delivery for both children. Instead, approximately six hours later, in the middle of the night, when the attending physician was no longer in the hospital, her first child was born at approximately 4:00 a.m. through a vaginal delivery. The attending physician arrived minutes before the delivery and after confirming that Twin B was still in a breach position, then decided to proceed with a c-section to complete delivery of Twin B. Unfortunately, this took over an hour and Twin B was born depressed with initial apgars of 2 at one minute and 7 at five minutes. Although Twin B was stable during the remainder of his hospitalization, his mother noticed over the ensuing months that he did not develop at the same rate as his sister. The differences, initially subtle, were dismissed by the pediatrician and not until Twin B was over a year old did it become apparent that he had a neurological injury. Defendants argued that none of his treating physicians linked his problem to a birth injury.

Duffy + Partners had the child’s records reviewed by a nationally-known pediatric neurologist who identified the causal link between the delay in delivery and the child’s neurological injury even though it took a year to manifest as seizures.

When we investigated the case, it became apparent that Twin B did not suffer a dramatic injury at birth but a subtle brain injury that led to the development of infantile seizures at approximately one year of age. The seizures then caused further brain damage. The defendants insisted that they were not negligent and that it was acceptable to wait an hour to deliver Twin B so long as monitoring revealed his condition was stable. In addition, defendants insisted that his apgar score of 7 at five minutes indicated that he was healthy at birth and sustained no harmful effects from the delay.

Our investigation revealed that the defendants failed to comply with the American Congress of Obstetricians and Gynecologists (ACOG) Guidelines for Monitoring Twin B while he was still in utero after his sister was born. In addition, the apgar score upon which they placed so much reliance was scored by the husband of the delivery obstetrician who happened to be the pediatrician on call that night. Further scrutiny of the apgar score revealed there was no worksheet reflecting how it was derived. Making matters worse, the cord gas ordered by the pediatrician, which would have reflected the extent of any acidosis in the infant’s blood, was never completed.

Defendants insisted that their doctors acted in accordance with the standard of care and that the delay in delivering Twin B caused no long term harm but ultimately agreed to a seven figure settlement approximately three weeks before trial.