Nurses question FHR tracing
<court>Hennepin County (Minn) District Court</court>
A 26-year-old woman at term presented to a hospital with ruptured membranes and clear amniotic fluid. The physician ordered oxytocin, but over the next 5 hours nurses twice halted its administration and contacted the obstetrician due to concerns regarding the fetal heart rate (FHR) tracing. Both times, oxytocin was resumed.
The physician reviewed the fetal monitoring strips after the second cessation, but when nurses called again approximately 1 hour later, opted not to review the strips and instructed the nursing staff to proceed as planned.
A vaginal exam 1 hour later revealed meconium, and fetal monitoring showed a 3-minute deceleration with a fetal heart rate in the 50s. The defendant ordered amnioinfusion and, following evidence of late variables, placed a scalp electrode.
Half an hour later the mother was fully dilated and began pushing, but dystocia was encountered, leading to 3 unsuccessful vacuum extraction attempts. Delivery was switched to cesarean. The child—born with Apgar scores of 1, 4, and 4—was diagnosed with hypoxic ischemic encephalopathy and is now in a vegetative state.
In suing, the plaintiff argued the physician should have halted oxytocin administration and delivered the child sooner.
The defendant claimed the child’s injuries stemmed from a sudden event immediately before delivery that could be neither predicted nor avoided.
- The case settled for $3.2 million.
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.