Sample Case: Birth Injury Timeline Analysis
Sample Scenario
In this sample scenario, a mother arrives at the hospital in active labor at 39 weeks gestation. During the labor and delivery process, there are signs of fetal distress that appear to go unaddressed for several hours. The baby is eventually delivered with severe hypoxic-ischemic encephalopathy (HIE) and is later diagnosed with cerebral palsy.
LNC Approach
In a case like this, a legal nurse consultant would create a detailed chronology that includes:
- Prenatal records and risk factors
- Labor and delivery records with precise timing of events
- Fetal monitoring strip interpretation at specific time intervals
- Nursing assessments and communications
- Physician notifications and responses
- Medication administration
- Decision-making timeline for interventions
- Neonatal resuscitation efforts and APGAR scores
- NICU admission and treatment
Sample Timeline Points
A chronology for this type of case might highlight key points such as:
- 7:30 AM: Patient admitted to labor and delivery; initial fetal heart rate (FHR) baseline 140-150 bpm with moderate variability
- 10:15 AM: FHR shows recurrent late decelerations; nurse documents but physician not notified
- 11:45 AM: Decreased FHR variability and continued late decelerations; nurse calls physician who orders position change and increased IV fluids
- 1:30 PM: FHR shows prolonged deceleration to 90 bpm lasting 3 minutes; physician notified but no change in management
- 3:15 PM: Severe variable decelerations with slow recovery; nurse documents "will continue to monitor"
- 4:45 PM: FHR shows minimal variability with persistent late decelerations; decision finally made for emergency C-section
- 5:30 PM: Baby delivered with APGAR scores of 2 and 4; requires extensive resuscitation
Potential Impact on the Case
A detailed chronology like this could demonstrate the progression of fetal distress and identify specific points where intervention should have occurred according to standard obstetrical practice. By correlating the fetal monitoring data with the actions (or inactions) of the healthcare team, the chronology can establish critical delays in care.
In similar cases, this type of timeline analysis has helped legal teams establish causation between delayed intervention and neurological injury, identify communication breakdowns, and demonstrate deviations from the standard of care in obstetrical emergencies.