Did too much oxytocin contribute to brain damage?
<court>Contra Costa County (Calif) Superior Court</court>
Upon admission for induction of labor, a 31-year-old gravida at 41 weeks’ gestation was given misoprostol, at 8 pm. At 5 am, the nurse began oxytocin based on the Ob/Gyn’s orders.
At 6:30 am, after examining the patient, the doctor diagnosed pregnancy-induced hypertension, ordered magnesium sulfate, and performed an artificial rupture of membranes. The physician then left the hospital to return to his office.
At 1:50 pm, fetal monitoring strips displayed decreased variability. Fifty-five minutes later, the oxytocin dosage was increased.
At 5:15 pm, the doctor returned to find the mother fully dilated and the infant in occiput-posterior position. Attempts to rotate the head proved unsuccessful; thus at 6 pm the Ob/Gyn opted for a cesarean delivery. A monitor attached in the operating room showed a fetal heart rate in the sixties.
At 6:23 pm, the child was born and had Apgar scores of 1, 3, and 4. A blood culture revealed Group D strep infection and a blood gas at 50 minutes of age showed metabolic acidosis. The child was later diagnosed with cerebral palsy and at age 3 was profoundly disabled.
In suing, the plaintiffs alleged that the combination of increased oxytocin, a nonreassuring fetal heart rate, and pregnancy-induced hypertension led to acute asphyxia at approximately 5:50 pm. Had cesarean delivery been initiated prior to this time, they contended, the child would have been normal at birth.
The defendant hospital maintained the oxytocin increases were reasonable, and claimed the fetal monitoring strips were reassuring with good variability for a woman receiving epidural medication and magnesium sulfate.
According to the defendant physician, computed tomography imaging showed that the child’s brain injury was sudden and abrupt, indicating acute cord compression. It was argued that this compression was unpredictable, and that the child’s ability to tolerate it was compromised due to the presence of severe Group D strep, as evidenced by her metabolic acidosis.
- The jury returned a defense verdict for the Ob/Gyn. They returned a gross verdict of $59.3 million against the defendant hospital. The present cash value of the gross verdict was determined to be $6.4 million for future medical costs plus $904,000 for future loss of earning capacity.
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.