On March 5, 2025, a South Carolina medical malpractice jury returned a $16 million medical malpractice verdict for the death of a newborn shortly after birth.
In April 2019, Dara Robinson found out she was pregnant. During her prenatal care, Dara experienced elevated glucose levels and the fetus was determined to be large for his gestational age.
On December 17, 2019, Dara went to the hospital because she was experiencing decreased fetal movement. She was hooked up to a fetal monitor that showed category two (indeterminate) monitor strips. There was meconium when the medical staff ruptured her membranes. While Dara was understandably concerned, her physicians exchanged text messages in which they discussed the fetal monitoring strips and discussed when to perform a cesarean delivery. Nonetheless, the C-section delivery was not performed for 30 hours after Dara arrived at the hospital. By that time, the fetal monitoring strips showed decelerations in the baby’s heart rate. The baby, a boy, was born alive but died shortly after birth.
Dara Robinson as PR of the Estate of E.R. v. Spartanburg & Pelham OBGYN, Spartanburg County Circuit Court, No. 2021CP4203497.
Fetal Monitoring
Intrapartum electronic fetal monitoring (EFM) is used for most women who give birth in the United States. In 2010, ACOG (American College of Obstetricians and Gynecologists) recommended a three-tiered system for intrapartum EFM interpretation:
Category I
• Category I FHR tracings include all of the following:
• Baseline rate: 110–160 beats per minute
• Baseline FHR variability: moderate
• Late or variable decelerations: absent
• Early decelerations: present or absent
• Accelerations: present or absent
Category II
Category II FHR tracings includes all FHR tracings not categorized as Category I or Category III. Category II tracings may represent an appreciable fraction of those encountered in clinical care. Examples of Category II FHR tracings include any of the following:
Baseline rate
• Bradycardia not accompanied by absent baseline variability
• Tachycardia
Baseline FHR variability
• Minimal baseline variability
• Absent baseline variability with no recurrent decelerations
• Marked baseline variability
Accelerations
• Absence of induced accelerations after fetal stimulation
Periodic or episodic decelerations
• Recurrent variable decelerations accompanied by minimal or moderate baseline variability
• Prolonged deceleration more than 2 minutes but less than10 minutes
• Recurrent late decelerations with moderate baseline variability
• Variable decelerations with other characteristics such as slow return to baseline, overshoots, or “shoulders”
Category III
Category III FHR tracings include either
• Absent baseline FHR variability and any of the following:
—Recurrent late decelerations
—Recurrent variable decelerations
—Bradycardia
• Sinusoidal pattern
ACOG recommended the following:
Category I FHR tracings may be managed in a routine manner because they are not associated with fetal acidemia.
A Category III FHR tracing is abnormal and conveys an increased risk of fetal acidemia at the time of observation.
Amnioinfusion has been shown to decrease the recurrence of variable decelerations as well as the rate of cesarean delivery for abnormal FHR patterns.
The following recommendations and conclusions are based on evidence that may be limited or inconsistent (Level B):
Intravenous fluid bolus, lateral positioning and oxygen administration, when used together, may improve fetal oxygenation during labor.
Regardless of whether labor is spontaneous or stimulated, tachysystole accompanied by Category II or Category III FHR tracing requires evaluation and initiation of appropriate treatment.
Category II tracings require evaluation, continued surveillance, initiation of appropriate corrective measures when indicated, and reevaluation. The presence of FHR accelerations (whether spontaneous or elicited) or moderate FHR variability or both are highly predictive of normal fetal acid–base status and, thus, may help guide clinical management.
The following conclusion is based primarily on consensus and expert opinion (Level C): The optimal time frame to effect delivery in the setting of a Category III FHR tracing has not been established.
If you or a loved one have suffered serious harm as a result of a birth injury in South Carolina or in another U.S. state, you should promptly find a South Carolina medical malpractice lawyer, or a medical malpractice lawyer in your state, who may investigate your birth injury medical malpractice claim for you and represent you or your loved one in a birth injury medical malpractice case, if appropriate.
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