Failure to Diagnose PPROM in a High-Risk Pregnancy Results in Twins with Permanent Disabilities
A woman with a known high-risk pregnancy was admitted to the hospital. Physicians failed to notice that her membranes had ruptured (premature rupture of the membranes), she was leaking amniotic fluid, and her twin boys were suffering from distress in the womb. For two days, amniotic fluid leaked out and away from the twins, and when the medical team finally decided to perform a C-section, the babies were born vaginally, before they could even reach the operating room.
The mother presented to the hospital, complaining of chest pains. She was only 29 weeks gestation when her contractions started. There was no sense of urgency on the part of the physicians; they did nothing to try and prevent the premature birth, and they failed to diagnose and treat the fetal distress. The medical team was unprepared for the type of delivery that ultimately occurred. One of the twins was born severely physically depressed and with severe respiratory deficits. He was later diagnosed with cerebral palsy. The other twin was moderately physically depressed, suffered respiratory problems, and was diagnosed with motor deficits and learning disabilities.
This case is indeed tragic because the physicians knew the mother was a high-risk pregnancy. She had been classified as high-risk because she had a history of obesity, hypertension, heart disease and myocardial infarction. The mother and twins should have been monitored very closely upon admission due to the fact that the pregnancy was risky and the woman had risk factors for premature rupture of the membranes (PROM), such as being pregnant with twins. But doctors failed to properly monitor the mother and diagnose the dangerous condition. Instead, the doctors decided to perform a C-section two days after admitting her.
Sadly, the lack of action on the part of the medical team caused permanent injury to the babies. Court documents allege that the hospital was negligent because it failed to act in a timely manner to delay the twins’ premature birth, diagnose and treat fetal distress, and perform a timely and proper delivery.
PPROM is an obstetrical emergency and requires immediate treatment.
PROM, or PPROM (preterm premature rupture of the membranes) as it was in this case, is an obstetrical emergency. PROM occurs during pregnancy when a woman’s water breaks before she goes into labor. PROM is defined as rupture of the membrane of the amniotic sac and chorion more than one hour before labor begins.
PPROM is PROM that occurs before 37 weeks gestation. This is dangerous because labor often begins soon after PPROM happens (usually within 48 hours). Babies who are born before 37 weeks are premature and can have serious health problems. When PROM and PPROM occur, it is necessary for the mother to receive antibiotics to avoid possible infection in the newborn, which can lead to premature birth, hypoxic ischemic encephalopathy, cerebral palsy, neurodevelopmental impairments, and intraventricular hemmorhage (IVH).
PROM and PPROM are crucial factors leading to fetal distress and other complications before labor or the end of the third trimester. Without sterile protective amniotic fluid, an unborn baby is prone to bacterial infections, nutrient loss, preterm birth, and other complications, including:
- Inflammation of the fetal membrane (chorioamnionitis)
- Infections in the mother or baby
- Premature birth
Doctors Must Pay Close Attention To The Risk Factors For And Signs Of PPROM
The causes of PROM are unclear. But PROM/PPROM is more likely to happen in women who:
- Have a twin pregnancy
- Had prior preterm labor and delivery
- Had prior preterm PROM
- Have an infection in the vagina or uterus (chorioamnionitis, sexually transmitted diseases)
- Have bleeding from the vagina
- Have poor nutrition
- Have had previous cervical surgery, including cone biopsies or cerclage
- Have had overstretching of the uterus and amniotic sac, which sometimes occurs with multiple fetuses or too much amniotic fluid (hydramnios)
- Have sepsis
- Have an anatomic defect in the structure of the amniotic sac, uterus, or cervix
In addition, if there is cord prolapse or malpresentation of the baby, PPROM is more likely to occur.
The most important symptom of PROM/PPROM is amniotic fluid leaking from the vagina. When a woman’s water breaks, it can feel like a sudden gush or a slow trickle of fluid from the vagina, and the fluid is clear or pale yellow.
PPROM Must Be Immediately Diagnosed So That Treatment Can Promptly Take Place
Physicians diagnose PROM/PPROM by using a speculum to determine if fluid is leaking from the cervix. A sample of fluid from the vagina will be examined and tested with special paper to verify that the fluid is amniotic. An ultrasound is used to determine the amount of amniotic fluid around the baby.
If PROM occurs before 34 weeks and there are no signs of infection, the physician may try to delay labor with medication (tocolytics) until the baby’s lungs are more mature. Antibiotics usually are given, and steroids are often given to help the baby’s lungs develop more quickly. The physician should collect a sample of fluid for analysis to determine if the baby’s lungs are mature, and if they are, labor will be induced.
When PROM takes place before 32 weeks of pregnancy, it is also best to delay delivery and treat with corticosteroids. Research shows that neonatal death, respiratory distress syndrome (RDS), IVH, necrotizing enterocolitis (NEC), and duration of neonatal respiratory support are significantly reduced by steroid treatment, without an increase in maternal or neonatal infection. Babies delivered this early often have RDS, bleeding in the brain (IVH), and intestinal problems (NEC).
Premature Rupture Of Membranes And Medical Malpractice
There are many complications that can occur when membranes rupture prematurely. If a woman has risk factors for PROM/PPROM, she and the baby must be closely monitored. And when PROM/PPROM take place, careful observation, planning, and monitoring for fetal distress is critical. Timing is very important in these instances. Guidelines must be followed to prevent infection and to ensure that the baby’s lungs are mature at birth. These factors take careful consideration and skill. If the medical team fails to follow medical guidelines and standards of care, properly monitor the infant, or perform a timely C-section when necessary, it is negligence. If this negligence leads to injury of the mother or baby, it is medical malpractice.
Reiter and Walsh ABC Law Centers have been helping families with birth injuries for many years. Contact our highly skilled attorneys for a free case review at 888-419-2229, or via live chat on the left of your screen.