Did delayed cesarean cause uterine rupture?
<court>Plymouth County (Mass) Superior Court</court>
A woman was admitted in the evening for induction of labor for a planned vaginal birth after cesarean (VBAC) delivery. Normal labor did not ensue after oxytocin was administered in the morning, and the fetal heart rate monitor strips revealed uterine hyperactivity and fetal distress, which worsened during the day.
The nurse assigned to the woman asked the charge nurse for advice; she was told to call the obstetrician. The physician claimed the labor was progressing satisfactorily and ordered continuation of the oxytocin. After alerting the charge nurse at 3:30 PM, the evening shift nurse and the charge nurse stopped the oxytocin at 4:00 PMand called the obstetrician at 4:10 PM. The physician returned to the hospital but did not order a cesarean until 20 minutes later.
The infant had a seizure shortly after birth, and the physician diagnosed hypoxic brain injury as a result of uterine rupture. The baby died 3 weeks later.
In suing, the woman claimed she was not advised of the risks of VBAC delivery, that the charge nurse failed to recognize early signs of fetal distress, that a cesarean should have been ordered much earlier in the day, and that it was negligent to allow labor to continue into the afternoon.
The obstetrician claimed the infant was healthy during early labor and faulted the evening nurse for not calling him back to the hospital sooner. The nurses claimed the physician had superior knowledge and said they could not be expected to recognize distress on the fetal monitor if the obstetrician could not.
- The parties reached a $1.25 million settlement.
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.