Is misoprostol wrong for induction?
<court>Charlottesville (Va) Circuit Court</court>
A 32-year-old woman at 38 2/7’s weeks’ gestation presented to a hospital for a scheduled induction due to gallstone pain and previous difficult delivery.
Her obstetrician gave 50 mg of misoprostol vaginally, but the woman’s cervix failed to dilate. Three hours later, the physician requested that a second ObGyn administer another 50-mg dose. Though the woman had contractions and increasing pain, cervical dilation did not begin for another 1.5 hours, after which steady progression occurred. She received an epidural and vaginally delivered a healthy infant girl.
Postpartum, the woman experienced rapid bleeding and passed a clot. Following oxytocin administration, her blood pressure dropped, after which a cervical tear was discovered. On exploratory laparotomy, the tear was found to extend to the woman’s uterus, requiring a hysterectomy. The procedure was successful and the woman made a full recovery.
In suing, the plaintiff claimed the tear stemmed from hyperstimulation due to excessive doses of misoprostol. She claimed the agent was not an appropriate choice since it is not approved for labor induction, and argued that the obstetricians failed to properly monitor her progress. She also argued that she did not provide informed consent.
The defense maintained that the tear was unrelated to the use of misoprostol, which they noted to be an appropriate agent that was properly administered.
- The jury returned a defense verdict.
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.