A Subacute Fetomaternal Hemorrhage
A 2,980-g 35-weeks' gestation female infant is delivered to a 30-year-old woman whose pregnancy was complicated by chronic hypertension. Four days before delivery she had a clinic visit, and fetal ultrasonography performed at that time was read as normal. Two days later (2 days before delivery), the woman called the clinic because she began experiencing chills, a “crampy feeling,” and loose stools. She reported good fetal movement.
Several hours later, she visited the emergency department because of additional symptoms of nausea, myalgia, back pain, and vomiting. During this visit, her temperature was 38.9°C. The long-term variability on a nonstress test (NST) was reported as fair, but one spontaneous deceleration was noted. The woman reported that fetal movements decreased from earlier in the day. (The monitoring strip was missing and unavailable for review at the time of litigation.) Complete blood count findings were unremarkable, and urinalysis showed 0 to 3 red blood cells and a large amount of hemoglobin. The plaintiff experts said the physician caring for the woman should have considered a transfusion reaction from the fetus because of the hemoglobinuria, the woman's symptoms, and the report of decreased fetal movement. A more detailed evaluation should have been performed, including a biophysical profile (BPP) and a Kleihauer-Betke test (KB). The box on the paperwork for “fetal movement” was left blank. The woman said in her deposition that she shared with the nurses that fetal movement was reduced. The plaintiff experts said this was the fetus' attempt to conserve energy because of the anemia. The defense experts said that the reduction in fetal movement meant that the damage already had occurred. The mother was discharged.
Later that day, the woman visited her obstetrician and had a repeat NST. The obstetrician read the NST as reactive, although he stated on his deposition …