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Medical Verdicts

Did excessive oxytocin result in mother’s death?

June 2002 · Vol. 14, No. 6
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<court>Orange County (Ny) Supreme Court</court>—A 35-year-old gravida presented to her obstetrician’s office with irregular contractions and a cervical dilation of 2 to 3 cm. A nonstress test was performed, and the physician advised the patient to go home and come back when her contractions were more regular. When the gravida returned, she was dilated 3 cm, but her contractions remained mild. She was sent to the hospital at 1:30 PM, and her membranes were artificially ruptured at 2:30 PM. However, cervical dilation and mild contractions persisted until 4:30. At 5 PM, oxytocin was administered and increased at 5:15 PM and 5:30 PM. At 5:35 PM, the patient complained of heart palpitations. The nurse turned the woman on her side, gave her oxygen, and withdrew the oxytocin. However, the mother became less responsive and went into cardiac arrest. A Code Blue was ordered at 5:51 PM.

At 6:08 PM, the baby was delivered via cesarean section; the infant was later diagnosed with choreoathetoid cerebral palsy. Early the next morning, the mother died. The autopsy revealed an amniotic fluid embolism.

In suing, the woman’s family claimed that the nurse should not have administered oxytocin and that the dosage was excessive. Further, the fetal monitor tracing showed abnormalities that warranted the withdrawal of the oxytocin prior to when it was finally discontinued. In addition, the plaintiffs argued that the physician should have been present when the oxytocin was administered. They also contended that the cesarean should have been performed earlier to reduce the risk of fetal damage.

The physician maintained that the augmentation of oxytocin was appropriate, given the patient’s lack of progress during labor. In addition, the Ob/Gyn argued that once the mother went into cardiac arrest, and there was a minimal likelihood of successful resuscitation, it was then appropriate to perform the cesarean, which was completed within 17 minutes—well within the standard of care.

The jury returned a verdict for the defense.

The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts. While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.

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