posted by admin on Feb 1
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1 Q You do know the difference between a
2 deceleration and bradycardia, don’t you?
3 A No. What do you mean?
4 Q A deceleration, as you’ve testified in many
5 other cases, is where the fetal heart rate goes down,
6 and then comes back up to baseline. A bradycardia, as
7 you have testified in other cases, is where the fetal
8 heart rate goes down and stays down.
9 MR. J.: Objection.
10 Q Using those definitions that you’ve given
11 in prior depositions, do you know if the 68 or 87 here
12 was part of a deceleration or a bradycardia?
13 MR. K.: This is J.Kelly. Objection
14 to form.
15 MR. J.: Objection also.
16 A Well, it was clearly bradycardia. You mean
17 whether it was associated with a uterine contracture –
18 contraction?
19 Q Well, decelerations are associated with
20 uterine contractions, that’s correct. If you need that
21 information, do you know whether the 68 or 87 was
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1 associated with a contraction or bradycardia?
2 A Well, I would call it bradycardia because
3 the levels were so low. I’m not sure I’d make that
4 distinction between bradycardia and deceleration.
5 Q Okay. Now that I’ve explained what a
6 deceleration is, are you familiar with the term
7 deceleration of the fetal heart rate?
8 A Yeah. Well, I guess what you’re saying, a
9 mild — a mild decrease in heart rate would be a
10 deceleration. I think if it went this low, you’d still
11 call it a bradycardia.
12 Q Okay. Do you know, after the heart rate
13 went to 68 or 87, whether or not the heart rate went
14 back to baseline?
15 MR. J.: While in ultrasound, Zeev?
16 MR. GERSHON: Yes, sir.
17 MR. J.: Okay. Thank you.
18 A No, I’m not sure.
19 Q And you also don’t know with a reasonable
20 degree of medical probability, correct?
21 A Yeah, that would be the same. I think
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1 “don’t know” you can translate as not reasonable
2 medical probability.
3 Q And, sir, assuming even hypothetically the
4 68 or 87 is part of a deceleration, you would not know
5 if it’s part of an early variable or late deceleration,
6 correct?
7 A I don’t think it — you’re making a useful
8 distinction. I think it’s bradycardia.
9 Q Do you know what obstetricians would use as
10 the definition for bradycardia?
11 A I would say below — below a heart rate of
12 a hundred.
13 Q And do you know how long the heart rate has
14 to stay below a hundred under the obstetrician’s
15 definition before it can be called a bradycardia?
16 A No, I don’t.
17 Q You mention in your report at the bottom,
18 “Although the slow heart rate and placenta previa
19 indicate that the threshold for injury had been
20 surpassed at the time of the ultrasound, I have no
21 information about how long before the ultrasound this
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1 had occurred.” Do you see that? Do you see that?
2 A Okay. Yeah. Surpassed –
3 Q You’re still reading? I’m sorry.
4 A “No information about how long before the
5 ultra-” – right. In other words, whether previous
6 episodes had also changed the cerebral blood flow.
7 Q Right. Now, when you mention that
8 sentence. “… the slow heart rate and placenta previa
9 indicate the threshold for injury had been
10 surpassed…,” what is it about the placenta previa, if
11 we dissect that out, indicates to you that a threshold
12 for injury has been surpassed?
13 A Well, I think it’s really the placenta
14 previa associated with the abruption that was noticed.
15 Q Why didn’t you mention the word “abruption”
16 in your report at all?
17 A I don’t know. It’s on the — it’s on the
18 ultrasound report. I’m not sure why I didn’t put that
19 in.
20 Q Okay. Are you saying basically when
21 there’s an abruption involved that a threshold for
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1 injury is surpassed?
2 MR. J.: In and of itself we’re
3 asking?
4 Q In and of itself. Or is it really the slow
5 heart rate that tells you the threshold for injury has
6 been surpassed?
7 A Yeah, I think it’s a combination of the
8 abruption with bradycardia.
9 Q Okay. Well, I’d like to isolate out the
10 abruption. What does an abruption tell you at all
11 about a threshold for injury being surpassed?
12 A Well, the abruption tells you that there’s
13 a potential for blood loss from the fetus, and the
14 bradycardia indicates that that blood loss probably has
15 been physiologically significant for the fetus. So
16 it’s really the combination.
17 Q Now I understand. Okay. Sir, would you
18 know, is there any literature out there concerning
19 fetuses who have had bradycardias before delivery and
20 correlating that with subsequent outcome?
21 A You mean with? With abruption.
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