Did inappropriate oxytocin cause uterine rupture?
<court>Orange County (Calif ) Superior Court</court>
A 30-year-old woman presented to a hospital in the early morning in labor with her first child; by phone, a physician ordered oxytocin administration.
The doctor instructed hospital staff to begin administration with 1 mU/min, with increases of 1 mU/min every 30 to 40 minutes. Despite this instruction, nurses increased the dose by 2 mU/min on 6 instances that day.
At approximately 1 PM, the physician performed an artificial rupture of membranes. At 5:30 PM, fetal monitoring revealed severe bradycardia; an emergency cesarean was performed 25 minutes later. Examination revealed uterine rupture. The child now suffers profound total-body spastic rigid cerebral palsy.
In suing, the plaintiffs noted that fetal monitoring strips showed decreased variability and repetitive late decelerations throughout the afternoon of delivery. They contended that the oxytocin dosage was increased on several occasions despite evidence of uterine hyperstimulation. Further, they claimed, the hyperstimulation resulted from inappropriate oxytocin administration.
The plaintiffs also argued that the Ob/Gyn should have noted dosing instructions were not being followed when she saw the patient at 1 PM; further, during a 4 PM phone call, the physician should have inquired as to the strength and frequency of contractions.
The doctor maintained it was the staff’s responsibility to carry out dosing orders as indicated and to inform the physician of any abnormalities in the labor.
The defendant hospital claimed that nurses are often called on to use discretion in dose increases, and that their actions were reasonable. Further, it was alleged, no clear indication of uterine hyperstimulation was present and abnormalities on the fetal monitoring strips were temporary. The hospital maintained the mother’s inherently weak uterus, not inappropriate oxytocin, was to blame for the rupture.
- The case settled for $4 million at mediation.
The cases in this column are selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska, of Nashville, Tenn. (www.verdictslaska.com) While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.