This page will discuss fetal heat monitoring strips and how they can be used as evidence in birth injury malpractice lawsuits. The goal of this page is to help explain the significance of fetal heart tracing and how they are supposed to be interpreted and utilized during labor and delivery.
Categories of Fetal Heart Tracing
Fetal heart tracing patterns (i.e., the rhythm of the baby’s heartbeat) are grouped into three categories: Category 1, Category 2, and Category 3.
Category 1 Fetal Heart Tracing
Category 1 fetal heart tracings indicate that the fetus has a normal acid-base status, meaning the baby is receiving sufficient oxygen. In simpler terms, a Category 1 tracing suggests that things are going well for the baby.
However, this doesn’t mean that healthcare providers should become complacent. It’s not uncommon for a mother to start with a Category 1 tracing and later need an emergency cesarean section due to a shift to a Category 3 tracing.
Therefore, it is crucial for nurses and doctors to closely monitor the fetal heart tracings and interpret them in the broader context of both the mother’s and fetus’s overall condition.
Category 2 Fetal Heart Tracing
A Category 2 fetal heart tracing is considered indeterminate, meaning it does not fit the criteria for either Category 1 (normal) or Category 3 (abnormal). It suggests that there may be some variability or concern in the fetal heart rate patterns, but it’s not definitively abnormal. Category 2 tracings can include features like:
– Variability in the fetal heart rate that is minimal or moderate
– Presence of periodic or episodic decelerations (drops in heart rate) that are not overly concerning or do not meet criteria for Category 3
– Accelerations (temporary increases in heart rate) may be present but are not required
While Category 2 tracings require closer monitoring and ongoing assessment, they do not automatically indicate a serious problem. However, since the condition of the fetus may change, healthcare providers will watch these tracings carefully and intervene if necessary.
Category 3 Fetal Heart Tracing
A Category 3 fetal heart tracing is considered abnormal and indicates that the fetus may be experiencing significant distress, with a high likelihood of inadequate oxygenation. This requires immediate evaluation and intervention to prevent serious complications.
Category 3 tracings are a sign that the fetus is in critical condition, and rapid interventions, such as an emergency cesarean section, may be necessary to ensure the baby’s safety.
Category 3: Minimal Variability With Decelerations
The primary focus of this page is on the types of Category 3 fetal heart tracing known as “minimal variability with recurrent decelerations.” This term describes a particular patter in the fetal heart rhythms. This particular fetal heart tracing is well known to be a strong indicator that the baby is under duress from oxygen depravation. Both minimal variability and continuing late decelerations are both indicative of oxygen deprivation, so when they occur together they are a major red flag.
From the moment a doctor or nurse observes minimal variability with recurrent decelerations, it serves as a loud warning that the baby’s oxygen reserves are rapidly depleting.
If healthcare providers fail to recognize or respond to this warning, which signals abnormal fetal acid-base status and hypoxia, the baby is at significant risk of serious birth injury or even death.
Causes for Minimal Variability With Recurrent Decelerations
Any type of obstetrical complication that interrupts the flow of oxygen from mother to baby during labor can potentially trigger minimal variability with recurrent decelerations. Some of the more common complications associated with this fetal heart tracing include umbilical cord compression and head compression.
Head compression is usually caused by external pressure on the head as it is pushed through the birth canal. Cord compression can be caused by prolapsed cord, short cord, nuchal cord and other complications.
What Does a Variable Deceleration Look Like?
A variable deceleration is a sudden drop in the fetal heart rate below the baseline, often resembling a sharp, pointed dip. The decrease is 15 beats per minute or more, lasting at least 15 seconds but less than 2 minutes from the start of the drop to the return to baseline.
The onset, depth, and duration of variable decelerations can differ with each uterine contraction. However, they are considered “recurrent” when they occur with more than 50% of contractions.
What is a “Shoulder” in a Fetal Heart Tracing?
A “shoulder” is a term often used to describe a particular pattern in a fetal heart tracing that can often be significant. The pattern is referred to as a shoulder because it has the appearance of profile of a head and a shoulder.
After each variable deceleration, the fetal heart rate briefly rises above the baseline for about 30 seconds. This represents the fetus attempting to recover and “gasping for breath” after each deceleration. The elevated heart rate following the contraction is the fetus overcompensating. This is yet another clear signal that immediate action is needed to deliver the baby.
Doctors and Nurses Have an Obligation to Monitor Fetal Heart Tracings
Healthcare providers have a duty to continuously monitor fetal heart tracings. This ongoing assessment is crucial for identifying any potential issues with the fetus’s well-being, ensuring timely intervention when necessary. By closely observing these tracings, doctors and nurses can detect abnormalities, respond swiftly to changes in fetal condition, and ultimately protect the health and safety of both the mother and the baby.
The whole point of monitoring the fetal heart rate during labor and delivery is to give the doctor and the delivery team critical information about the baby’s status so that they can take appropriate action in response. In most cases, when a baby is under serious distress, the crisis can be averted with an emergency C-section.
This is exactly why monitoring and properly interpreting fetal hear tracing patterns is a critically important part of obstetric healthcare. It is also why fetal heart tracings are often the central piece of evidence in birth injury malpractice lawsuits.
Fetal Heart Tracing Verdicts and Settlements
- $12,000,000 Settlement (New Jersey 2024): Infant suffered progressively worsening/non-reassuring fetal monitor tracings and tachysystole during his delivery, while under the care of defendants. He suffered HIE brain injury was diagnosed with cerebral palsy. The lawsuit alleged medical negligence, including that the defendants negligently failed to properly interpret fetal heart tracings and toco strips; failed to timely recognize, assess and respond to non-reassuring fetal heart rate tracings.
- $10,000,000 Settlement (New York 2024): The plaintiff asserted negligence in failing to timely respond to indications of progressive fetal and/or maternal risk (recurrent deep prolonged decelerations in fetal heart rate), failing to timely order and perform a c-section, and failing to properly expedite delivery in the face on non-reassuring fetal heart tracings, among other failures. The baby suffered severe brain and permanent catastrophic neurological injuries.
- $5,800,000 Settlement (New Jersey 2024): The infant plaintiff allegedly suffered injuries due to prolonged labor and failure to perform an immediate C-section, even with unstable fetal monitoring and obvious deteriorating conditions that reportedly led to acidotic, hypoxic, and metabolic compromise. When a C-section finally was performed, the plaintiff reportedly was found partially outside the uterine wall.
- $3,500,000 (New York 2024): The mother was very close to her due date when she fell on her stomach. She went to the hospital and the defendant OB/GYN placed an external fetal monitor on her. The defendant allegedly was negligent in failing to monitor and properly interpret warnings indicators on the monitoring strips. As a result, mother suffered a placental abruption that went noticed for too long before an emergency C-section could be performed. The child suffered severe brain injuries leaving him blind and with no functional movement at all.
- $4,800,000 (California 2023): The lawsuit alleged that soon after administering Pitocin the fetal heart tracings recording very concerning and abnormal patterns. A C-section was not ordered until 5 hours later, by which time the baby had suffered brain damage resulting in permanent disability.
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