At 3.30pm she was re-examined and found to be 3cm dilated and was given 100mg pethidine IM.
At 8.30pm she was examined by the midwife again and still found to be 3cm dilated. The cardiotocograph (CTG), which had been started one hour before, was normal, with a baseline of 140b/min and good variability and good reactivity. Mrs G was now experiencing more painful contractions and an epidural was sited.
At 10pm, she was found to be 3cm dilated and the “membranes were still intact”, despite still having regular contractions of three every ten minutes. No artificial membrane rupture was carried out; however, Mrs G was started on a syntocinon regime by the midwife. There was no documentation as to whether this was carried out after verbal advice from the doctor or not, but no written prescription could be found on the drug chart, when the notes were reviewed retrospectively.
At 12.30am the CTG had become “suspicious”, with the baseline 150b/min and typical variable decelerations and the contractions were coming five every ten minutes. Dr A, the staff grade obstetrician on-call, was notified and he advised “verbally” to stop the syntocinon infusion, change the position of Mrs G and give her oxygen. The midwife felt the CTG improved after this.
At 3am, Mrs G was re-examined and her cervix was found to be 6cm dilated with “bulging membranes”. These were artificially ruptured and she was found to have grade II meconium. The CTG baseline had risen to 180b/min and there were deep late decelerations and the contractions were still strong, coming four every ten minutes, despite having stopped the syntocinon. Dr A was informed, but he was “busy” and had still not arrived to review the CTG by 3.35am.
He was re-contacted and came to assess Mrs G at 4am. He felt she was now “fully dilated” with the head at the level of the ischial spines. He decided to carry out a ventouse delivery, which was started at 4.15am. This was recorded as a “difficult delivery”, but no other documentation was made. The 3.9kg baby girl was delivered at 4.35am with an Apgar score of 3 at one minute after birth, and 6 at five minutes. The cord gases showed severe metabolic acidosis with a pH 6.9 and BE-18 (arterial). The paediatricians were called subsequently and the baby was transferred to NICU. Although the baby survived, she had significant hypoxic ischaemic encephalopathy and severe cerebral palsy as a result.
Mrs G made a claim against Dr A and his team for their failure to adequately monitor her baby and recognise signs of fetal distress. This lack of communication between the teams and lack of recognition of the severity of the condition resulted in the infant having severe cerebral palsy, requiring lifelong care.
The claim was settled for a substantial sum.