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Newborn Brain Injury Due to Failure to Place a Cervical Cerclage

Lawsuit Against Johns Hopkins Hospital | September 1, 2020

On September 1, 2020, WVFO attorneys Keith Forman and Jermaine Haughton filed a medical malpractice claim on behalf of a minor child who suffered a brain injury due to the failure to prolong his mother’s pregnancy with a cervical cerclage.

The complaint alleges that on September 15, 2017, the child’s mother had a routine prenatal visit for her 20-week fetal anatomy survey at Johns Hopkins, where it was discovered that her cervix was shortened, and that her external os “appeared to be dilated to 1.3 cm.” Short cervical length is defined as less than 2.5 cm prior to 24 weeks of gestation, and places a woman at increased risk for preterm birth. The mother was evaluated for a cervical cerclage, which is a treatment for cervical shortening, which causes preterm birth. By reinforcing the cervix, a cerclage prevents preterm premature rupture of membranes, intra-amniotic infection, and premature labor and delivery. A speculum exam showed a cervical length of 1.1 cm and 1 cm dilated. The final diagnoses were cervical shortening and cervical incompetence. In accordance with the standard of care for these diagnoses, the mother was counseled on the risks, benefits, and alternatives for cerclage placement or vaginal progesterone with cervical length surveillance. The mother initially opted for the progesterone but she returned the next day to express that she now desired a cervical cerclage. This request was documented in her medical records. The mother’s cervix was described as closed with a cervical length of “1.5 cm with some funneling.” Contrary to the mother’ wishes, the unilateral decision was made to forego cerclage placement, and to continue instead with vaginal progesterone. The conclusion that a cerclage was not indicated was a deviation from the standard of care – especially in light of the diagnosis of cervical incompetence made one-day prior. The child’s mother returned to Johns Hopkins on September 22, 2017, when she was 21 weeks pregnant. An ultrasound found no closed portion of cervix and that the internal cervical os was dilated to 1.3 cm and the length of the open cervix measured 2.4 cm. Based on the fact that the mother’ cervix was now completely open, and dynamic changes were noted, the standard of care required that the doctors re-offer the option of having a cerclage placed. The child’s mother presented for her cervical evaluation ultrasound on October 6, 2017. Her cervix was noted to be 0.44 cm in length. On October 7, 2017, the mother (now 23 weeks and 1-day gestation) was evaluated, however, in violation of the standard of care, the doctors failed to discuss or re-offer cerclage as an option for her at that time. They instead placed a pessary. A follow up cervical examination at 24 weeks’ gestation (October 13, 2017) again revealed “no closed portion of the cervix.” Despite this finding, the child’s mother was still not re-offered the benefit of a cerclage. The child’s mother returned to labor and delivery on October 17, 2017, and was unsurprisingly admitted with preterm premature rupture of membranes. She was 24 weeks and 4 days pregnant. Days later, she was diagnosed with chorioamnionitis, so labor was induced. At birth, the child weighed 1 pound and 10.8 oz. His Apgar scores were 2, 7, and 9 at one, five, and ten minutes, respectively. A pediatric note on December 18, 2017 stated that the child was “[a]t risk for developmental delay and sensory processing disorder.” Today, the child suffers from significant neurodevelopmental and physical issues, including but not limited to global developmental delay, cognitive impairment, adjustment disorder, and autism.

The child’s injuries were a result of the negligence of Johns Hopkins Hospital and its employees. The lawsuit alleges that the defendants failed to offer cervical cerclage to prolong the mother’s pregnancy and improve the child’s outcome. The child will require significant medical care and treatment for the rest of his life.

The action is pending in the Circuit Court for Baltimore City, Maryland.

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