This case involves a young mother who went into induced labor after experiencing a number of complications with her pregnancy. During labor, the patient began to appear discolored, and testing revealed progressive signs of fetal distress. The decision was made to proceed to urgent delivery via vacuum extraction. During the extraction additional complications, including shoulder dystocia, were encountered, and the mother suffered a uterine rupture. The infant suffered a number of injuries during her delivery, and was eventually diagnosed with cerebral palsy. It was alleged that doctors should have opted for a cesarean section instead of a vacuum extraction, which would have avoided injuries to both mother and her daughter.
Question(s) For Expert Witness
- 1. What is the proper protocol when observing progressing signs of fetal distress while inducing labor?
- 2. What steps could have reduced this patient's risk for uterine rupture? Please explain.
- 3. Do you frequently treat patients similar to the patient describe in this case?
Expert Witness Response E-009197
As the a professor of obstetrics and gynecology and as the residency director at a university affiliated medical center, I frequently treat patients similar to the patient described in this case. This case is right in my area of expertise. My concern is that there could have been greater continual monitoring which is the proper protocol when observing progressing signs of fetal distress. In a case like this, one wants to continually monitory as to so not miss any fetal patterns, check in that the fetal heart rate is reassuring, mitigate all risks, and properly time a c-section.
Expert Witness Response E-000106
The protocol for a nurse in this scenario is to discontinue the Pitocin, turn the patient to her left side, administer O2, increase the iv fluid rate and give Terbutaline if the patient is hyperstimulated. The attending physician should be immediately notified. C-section probably should have been done earlier. Pitocin should have been correctly given/not given. In my 30+ years as an obstetrician, I have managed patients similar to this patient. However, I adhered to the standard of care and had a good maternal and fetal outcome.