Case Study: Traumatic Delivery or Poorly Managed Gestational Diabetes?

Repurposed from The Scope, Second Quarter 2025

This case involved allegations of negligent labor and delivery on a woman with gestational diabetes, with the use of a vacuum extractor. There was also a claim of negligent neonatal care for hypoglycemia in the hours after the child’s birth. Damages included fracture of the left humerus, a right Erb’s palsy, cognitive impairments, developmental delays and severe and permanent brain damage.

Patient Presentation and Treatment

The patient in this action, a then 34-year-old female, had an obstetrical history of four pregnancies and no live births. Her prenatal course was complicated by gestational diabetes requiring glyburide, and she had a prenatal history of hypertension and was on hydrochlorothiazide.

At 35 ½ weeks gestation, the patient presented to Labor and Delivery at a hospital following premature rupture of membranes. She was 3-4 cm dilated, and contractions were 2-3 minutes apart. The patient was admitted, and the MLMIC-insured OB-GYN physician was contacted, as he was the physician on call. It should be noted that all of the patient’s prenatal treatment was rendered by another physician, who was not named in the eventual lawsuit. The patient was administered an epidural for pain, and the fetal monitoring strips revealed mild late decelerations followed by a normal reactive pattern. The labor was augmented by Pitocin, and she was making good progress.

The patient pushed for approximately two and a half hours and was experiencing maternal exhaustion. The OB-GYN performed a vaginal delivery that included vacuum assistance with three to four pulls of moderate force. Shoulder dystocia was encountered, with one loop of cord around the fetus’s neck. Due to the shoulder dystocia, suprapubic pressure and the McRoberts’ maneuver were employed. A 7 lb. 15 oz. male was delivered with an Apgar score of 3/7/8. The neonatology team was present, and the MLMIC-insured neonatologist immediately started tending to the infant. The infant required bagging with 100% O2. He was then intubated and transferred to the NICU.

The infant was diagnosed with perinatal distress/ depression, respiratory distress, hypoglycemia, a left humerus fracture, right shoulder dystocia, and he had mild hypotonia, molding, and a small abrasion on the right parietal scalp. His glucose level was 11 (50 is normal). Bolus injections were ordered with hourly checks. The neonatologist then placed an umbilical artery catheter and an umbilical venous catheter (UVC). After confirmation of position of the catheters by radiology, an IV of dextrose 15% in water was started at 80 ml per day. The dextrose was subsequently increased to 20%. The glucose level was brought up to normal within six hours.

The infant was transferred to another hospital where he remained in neonatal intensive care for almost two months. He was then transferred to Pediatric Intensive Care, where he had a stormy course that included three surgeries. A subsequent MRI demonstrated a subarachnoid and a subdural hemorrhage.

Lawsuit Filed

The mother and natural guardian brought a lawsuit against the MLMIC-insured OB-GYN and neonatologist and the hospital. She claimed that the OB-GYN failed to promptly recognize the potential for shoulder dystocia and that a cesarian section should have been performed based on the fetal monitoring strips. In addition, the plaintiff claimed that the events, including the late decelerations and the difficulty in extracting and affecting delivery, resulted in a traumatic delivery and a hypoxic ischemic event.

The plaintiff claimed that the neonatologist failed to timely and appropriately treat the infant’s hypoglycemia in the hours after birth. Specifically, he did not properly administer intravenous glucose and, as result, the infant suffered from brain damage.

Prior to trial, the plaintiff settled the case with the OB/GYN in the amount of $2.3 million. As there was no offer of settlement on behalf of the neonatologist, the case against him went to trial with the claims focused solely on the management of the infant’s hypoglycemia immediately after birth.

At trial, the plaintiff’s expert testified to departures from the standard of care in the treatment of the infant’s hypoglycemia. Specifically, it was alleged that the neonatologist should have started a continuous IV drip sooner to run the continuous glucose. Also, it was alleged that he unnecessarily delayed treatment by waiting for radiologic confirmation of the UVC line placement instead of checking the film himself and starting the infusion sooner.

The now 5-year-old plaintiff was brought into the courtroom in a stroller and examined by his pediatric neurologist in front of the jury. The child was shown to have poor muscle tone, he could not stand on his own for longer than 30 seconds, and he had limited vocabulary, saying only “hi” and “bye.” The jury smiled at the cuteness of the child, but none cried or got exceptionally emotional. It was evident, however, that the child was severely damaged and developmentally delayed. As expected, there was testimony from an economist who opined that the child’s medical expenses and lost income would be close to $24 million.

MLMIC’s neonatology expert testified that the infant was treated correctly and in accordance with the American Academy of Pediatric guidelines, which say you can treat neonate hypoglycemia with either a bolus or continuous IV dextrose. Our expert also testified regarding causation. He opined that the plaintiff’s gestational diabetes was poorly managed, which caused the infant’s brain to suffer during the in-utero period.

MLMIC’s pediatric neurology expert did an effective job explaining that the child’s injuries were not related to hypoglycemia, as none of the MRIs obtained showed any evidence of acute hypoglycemia and none of the doctors treating the child had ever documented that the infant’s injury was caused by hypoglycemia. The expert further testified that there very likely was a genetic component to the child’s problems.

Due to the highly sympathetic nature of this case, while the jury deliberated, MLMIC and the plaintiff discussed a possible high/low agreement, which places a ceiling and a floor on the amount of money awarded at trial, guaranteeing that a minimum amount will be received by the plaintiff regardless of the verdict. Before any figures could be finalized, the jury returned 75 minutes later with a verdict in favor of the neonatologist.

When the defense counsel was able to speak with the jurors after the verdict, they all felt neonatologist did not substantially contribute to the infant’s severe neurological damage. Interestingly, they felt the real culprit was the traumatic delivery.

Legal Analysis

The plaintiff in this case criticized the MLMIC-insured neonatologist’s clinical judgment with respect to choosing the treatment course of continuous IV versus bolus. Clinical judgment is often a factor contributing to malpractice allegations. When clinical judgment is called into question, as it was in this case, the defense must establish that the judgment of the physician was in accordance with the standard of care.

This trial came down to a battle of the experts. Fortunately, MLMIC’s expert was able to point to the American Academy of Pediatric guidelines to establish the standard of care for treating hypoglycemia in an infant. While this was a catastrophic case for the infant, an incorrect verdict was avoided when the jury agreed that the neonatologist’s clinical judgment was in accordance with the standard of care.

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This document is for general purposes only and should not be construed as medical, dental or legal advice. This document is not comprehensive and does not cover all possible factual circumstances. Because the facts applicable to your situation may vary, or the laws applicable in your jurisdiction may differ, please contact your attorney or other professional advisors for any questions related to legal, medical, dental or professional obligations, the applicable state or federal laws or other professional questions.