Allegation:
Failure to appropriately manage and treat a patient's labor resulted in acute injury to the child before and during delivery.
The Case:
The patient, a 32 YOF (5’3”, 183 lbs., primigravida), presented to the hospital complaining of HTN. Upon admission, FHTs were in the 130s, and the patient’s B/P was 130/80. At midnight, Pitocin® was started at 2mU and increased to 4mU at 03:04, 6mU at 05:56, and 8mU at 06:18, which was the last Pitocin increase documented on the fetal monitoring strips. The remaining Pitocin increases were entered on the OB Flow Sheet, a handwritten document kept at the patient’s bedside. Pitocin was increased to 10mU at 7:00, and to 12mU at 07:30. The patient’s cervix was 4 cm dilated, 70% effaced, and the fetus was at -2 station.
At 08:00, physician coverage rotated to the defendant ob-gyn’s care. He reviewed the FHT strips that showed the patient was having contractions every 2 to 2½ minutes with decreased beat-to-beat variability. The defendant ob-gyn reviewed the fetal monitoring strips from 08:32-08:40 and from 08:40-08:48. He did not see any tracings he found concerning. At 08:30, the nurse increased the Pitocin to 16mU, and at 09:00 to 18mU, where it remained for the duration of the patient’s labor. Variables were noted at 09:28, and oxygen was applied at 8L per min. At that time, the defendant ob-gyn did not see any sign of hypoxia on the corresponding monitoring strip and believed the strips showed consistent progress of labor.
The patient began pushing at 10:00. At 10:04, the patient’s cervix was completely dilated; the nurse notified the physician at 10:06. At approximately 11:00, the defendant ob-gyn was notified that another L&D patient was completely dilated and had begun pushing. The defendant ob-gyn testified that he would have notified the nursing staff that he was going into the second patient’s delivery, and may not be available for the patient’s delivery.
At 11:00, the nurse noted the fetus was experiencing variables with pushing to the 90s, which lasted 30-80 seconds. At 11:14, the FHT dropped to 60 for approximately 80 seconds. At 11:17, Pitocin was turned off. FHTs were in the 60s. Nursing paged another physician emergently to the bedside since the patient’s physician was involved in another delivery. Upon assessment of fetal position, the fetus was transverse at +1 station with persistent bradycardia. At 11:24, the decision was made to proceed with a stat C-section.
The infant was delivered at 11:39 without a pulse or respirations, and a code was called. Mechanical ventilation was started when the infant arrived in the NICU. After discussion with a neonatology physician, the decision was made to transport the infant to a higher level of care for hypothermia control. After transfer, the infant suffered two code events.
About 10 days after birth, an MRI showed brain stem infarction. The child was diagnosed with quadriplegic cerebral palsy and seizure disorder. He was blind, and would not be expected to walk or talk. The patient was discharged home about six weeks after birth.
About eight and a half years later, the child presented to the hospital following a cardiac arrest at home, and was pronounced dead at 9 years old.
Multiple defense experts included neonatologists, maternal fetal medicine, and ob-gyn physicians. These physicians testified the infant experienced an acute bradycardia event at 11:14 that was profound, unpredictable, and irreversible, and most likely caused by a complete cord compression. Furthermore, the experts believed the infant’s acute ischemic insult took place over a 10-minute period before delivery, and there was no indication to perform a C-section prior to the unpredictable event. No one believed an earlier delivery would have made any difference in the outcome.
The plaintiff’s expert witnesses testified the infant began experiencing asphyxia during the course of labor, such that the infant was in a depressed and compromised state when the cardiovascular collapse occurred. The experts further testified the infant suffered from repeated cord compromise, and the fetal monitoring strips were consistent with the same. One nurse testified they should have stopped the Pitocin, and the physician should have been notified when late decelerations were seen as early as 09:32.
Defense argued the injury to the child was an acute, profound insult at the end of the patient’s labor, and there was nothing the defendant ob-gyn did throughout the course of labor that was below the standard of care that caused injury to the child.
Verdict:
The jury returned a verdict in favor of the defense.
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