Fetal heart rate monitoring is necessary in assessing the well-being of the fetus during pregnancy and labor. Through it, healthcare providers can evaluate an infant’s well-being and detect any signs of distress.
As such, fetal heart rate decelerations are temporary decreases in the fetal heart rate, and there are three main types:
- Early decelerations – These are shallow, brief decelerations that occur during uterine contractions. They are generally considered normal and are not cause for concern.
- Variable decelerations – These are abrupt and irregular decelerations often associated with umbilical cord compression. While this generally occurs once in every labor (right before the baby pops out), prolonged spikes and drops in fetal heart rate can seriously harm the baby.
- Late decelerations – These are gradual decelerations that start after the peak of a uterine contraction or after the contractions have finished. In some cases, they could be a sign that the baby is not getting enough oxygen.
Fetal heart rate decelerations are considered recurrent when they occur with a certain frequency and consistency over a specified period of time during labor.
What Are Recurrent Late Decelerations?
Recurrent decelerations are defined as those that occur in more than 50% of uterine contractions in any 20-minute window, as stated in this guideline. It is taken from the National Institute of Child Health and Human Development (NICHD) and considered to be the most prominent guideline in the United States
In the NICHD Fetal Heart Rate Classification System, recurrent late decelerations are considered Category III – meaning they are among the most concerning incidents during childbirth. This incident has a high likelihood for fetal neurological injury, or even stillbirth if severely mistreated.
Several maternal factors can contribute to the occurrence of recurrent late decelerations. Healthcare providers must consider and successfully navigate through these complications. Failure to do so may constitute medical malpractice, warranting further legal action.
Some of these conditions that should be considered by healthcare providers include (but are not limited to):
| CONDITION | DESCRIPTION |
| Maternal Hypotension | Certain unideal maternal positions, certain pain relief medications, dehydration, and blood loss can lead to a drop in maternal blood pressure. |
| Uterine Hyperstimulation | These are excessive uterine contractions – either spontaneous or induced by medications. They can impair placental perfusion and oxygenation. |
| Hypertensive Disorders | These conditions can cause placental insufficiency and reduced fetal oxygenation. Some specific examples include preeclampsia and gestational hypertension. |
| Autoimmune Disorders | These conditions can affect placental function and fetal well-being. Some relevant disorders include systemic lupus erythematosus and antiphospholipid syndrome. |
| Maternal Obesity | Obesity is associated with an increased risk of placental insufficiency and fetal distress. |
| Maternal Anemia | Severe anemia can reduce the oxygen-carrying capacity of maternal blood, affecting fetal oxygenation. |
| Other Maternal Medications | Some medications, such as magnesium sulfate (used for preeclampsia or tocolysis), can cause maternal hypotension and reduced placental perfusion |
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Potential Maternal Risks
When recurrent late decelerations are not managed properly, emergency cesarean deliveries are typically done to prevent any potential injuries to the baby. Under such contexts, mothers may suffer from the following complications:
- Increased blood loss
- Infection
- Thromboembolism
- Anesthetic complications
- Postpartum hemorrhage
Apart from serious medical damages, mishandled late decelerations may cause severe emotional and psychological trauma – should a family be met with tragic outcomes. Feelings of guilt, anxiety, and/or depression typically follow complicated deliveries with poor outcomes.
To prevent maternal and fetal risks, it is crucial for healthcare providers to:
| 1. Promptly identify and respond to recurrent late decelerations; 2. Implement appropriate interventions to improve fetal oxygenation, such as maternal position changes, oxygen administration, or intravenous fluid therapy; 3. Continuously monitor fetal heart rate and assess fetal well-being; 4. Make timely decisions regarding the need for emergency delivery, such as cesarean section, when fetal status does not improve despite interventions; and lastly 5. Provide comprehensive neonatal care and follow-up for infants affected by fetal hypoxia and acidosis. |
Potential Infant Risks
Prolonged oxygen deprivation of a fetus’ brain, causes life-threatening damages. Children who survive will unfortunately struggle from life-altering medical conditions. These conditions include:
| CONDITION | DESCRIPTION |
| Hypoxic-ischemic encephalopathy (HIE) | HIE can result in cognitive, motor, and sensory impairments, as well as developmental delays. The severity of HIE can range from mild to severe, with the most severe cases leading to permanent neurological damage or even death. |
| Cerebral palsy | Cerebral palsy is a group of disorders affecting movement, posture, and muscle tone. Children with cerebral palsy may experience motor impairments, intellectual disabilities, seizures, and other associated conditions. |
| Neonatal seizures | Fetal hypoxia and acidosis can lower the seizure threshold and cause neonatal seizures. Seizures in newborns can be difficult to control and may require prolonged treatment with anticonvulsant medications. |
| Multi-organ dysfunction | Prolonged fetal hypoxia can affect multiple organ systems, including the heart, kidneys, and liver. This can lead to complications such as cardiac dysfunction, acute kidney injury, and liver failure in the neonatal period. |
| Meconium aspiration syndrome (MAS) | Fetal distress can cause the release of meconium (the baby's first stool) into the amniotic fluid. If the fetus inhales meconium-stained amniotic fluid, it can lead to MAS, a respiratory disorder causing inflammation and obstruction of the airways. |
In more severe cases, stillbirths may occur. Trauma in infants can also lead to neonatal deaths.
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Establishing Liability for Compensation
Naturally, late evaluations pose a great risk to the well-being of mothers and infants. Such events occur when laboring mothers are not provided with the proper medical attention that they need. And so, such negligence ultimately delays testing, diagnosing, and treatment.
Multiple errors also cause miscommunication and confusion within a medical team. This could further aggravate any potential damages that would be made by a medical team.
Before formalizing a medical malpractice claim, four key elements must first be established. These key elements include:
| 1. Duty of Care – Was there an appropriate doctor-patient relationship? |
| 2. Breach of Duty – Did your doctor perform poorly/negligently based on accepted standards of care? |
| 3. Causation – Did your doctor’s actions/inactions directly cause you harm? |
| 4. Damages – What did these errors cost you? |
Apart from establishing your claim, the responsibilities of your medical malpractice lawyer include gathering pieces of evidence; officially filing your case; and negotiating for your compensation.
Speak to a Birthing Injury Lawyer Today
At the Porter Law Group, our team of proven medical malpractice lawyers delivers ideal results. We take pride in helping families rebuild after unfavorable circumstances. We operate on a contingency basis – meaning you do not need to pay us anything unless we win your case. Through this approach, we can better support families during their times of need.
If you or a loved one has been a victim of medical malpractice, please reach out to us for a non-obligatory free case evaluation. You can also contact us at 833-PORTER9 or info@porterlawteam.com to schedule a consultation.
