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Did too much oxytocin contribute to brain damage?
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.
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.
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.
Grandma’s videotape disputes OB’s account of dystocia
A child suffered Erb’s palsy following shoulder dystocia encountered during delivery. As a result, he cannot fully extend, rotate, or raise his right arm, which is 1 inch shorter than his left.
The defendant Ob/Gyn contended that, in an effort to dislodge the shoulder, he applied gentle downward traction with his fingers. He also argued that an intrauterine event led to the injury.
However, videotape of the birth taken by the plaintiff’s grandmother showed the physician pushing down on the child’s head with both hands, rotating the head, then applying additional traction. After the infant’s birth, the physician is shown raising and releasing the affected arm, which fell limply to the child’s side.
This footage conflicted with the physician’s notes, which did not indicate the second application of traction or the examination of the right arm.
The plaintiff maintained that excessive force at birth was responsible for the Erb’s palsy and sequelae.
- The jury awarded the plaintiff $1.05 million.
A child suffered Erb’s palsy following shoulder dystocia encountered during delivery. As a result, he cannot fully extend, rotate, or raise his right arm, which is 1 inch shorter than his left.
The defendant Ob/Gyn contended that, in an effort to dislodge the shoulder, he applied gentle downward traction with his fingers. He also argued that an intrauterine event led to the injury.
However, videotape of the birth taken by the plaintiff’s grandmother showed the physician pushing down on the child’s head with both hands, rotating the head, then applying additional traction. After the infant’s birth, the physician is shown raising and releasing the affected arm, which fell limply to the child’s side.
This footage conflicted with the physician’s notes, which did not indicate the second application of traction or the examination of the right arm.
The plaintiff maintained that excessive force at birth was responsible for the Erb’s palsy and sequelae.
- The jury awarded the plaintiff $1.05 million.
A child suffered Erb’s palsy following shoulder dystocia encountered during delivery. As a result, he cannot fully extend, rotate, or raise his right arm, which is 1 inch shorter than his left.
The defendant Ob/Gyn contended that, in an effort to dislodge the shoulder, he applied gentle downward traction with his fingers. He also argued that an intrauterine event led to the injury.
However, videotape of the birth taken by the plaintiff’s grandmother showed the physician pushing down on the child’s head with both hands, rotating the head, then applying additional traction. After the infant’s birth, the physician is shown raising and releasing the affected arm, which fell limply to the child’s side.
This footage conflicted with the physician’s notes, which did not indicate the second application of traction or the examination of the right arm.
The plaintiff maintained that excessive force at birth was responsible for the Erb’s palsy and sequelae.
- The jury awarded the plaintiff $1.05 million.
Bowel perforation follows fetal demise, D&E
After contracting Parvovirus, a 36-year-old woman suffered fetal demise at 23 weeks’ gestation. Cervical ripening was begun in preparation for a dilation and evacuation (D&E) of the fetal remains. The physician intended to continue this ripening the following morning, but the woman developed a fever and returned to the hospital later that evening.
The physician opted to conduct the D&E that night, but in the course of surgery perforated the woman’s uterus and delivered the bowel vaginally. As a result, the patient underwent a 5-hour procedure consisting of a hysterectomy with unilateral salpingo-oophorectomy, bowel resection, and colostomy.
The woman sued, claiming the surgeon was negligent in injuring her bowel. She further alleged lack of informed consent and improper preparation of the cervix. She argued that in addition to sterility and vaginal scarring, she suffers urinary and bowel incontinence. She maintained that resultant psychological injuries, psychosexual dysfunction, and physiological difficulties have led to problems in her sexual relationship with her husband.
The defense noted that the injuries were known complications of the D&E procedure—a medically necessary intervention. They maintained that sound clinical judgment was exercised at all times.
- The jury returned a defense verdict.
After contracting Parvovirus, a 36-year-old woman suffered fetal demise at 23 weeks’ gestation. Cervical ripening was begun in preparation for a dilation and evacuation (D&E) of the fetal remains. The physician intended to continue this ripening the following morning, but the woman developed a fever and returned to the hospital later that evening.
The physician opted to conduct the D&E that night, but in the course of surgery perforated the woman’s uterus and delivered the bowel vaginally. As a result, the patient underwent a 5-hour procedure consisting of a hysterectomy with unilateral salpingo-oophorectomy, bowel resection, and colostomy.
The woman sued, claiming the surgeon was negligent in injuring her bowel. She further alleged lack of informed consent and improper preparation of the cervix. She argued that in addition to sterility and vaginal scarring, she suffers urinary and bowel incontinence. She maintained that resultant psychological injuries, psychosexual dysfunction, and physiological difficulties have led to problems in her sexual relationship with her husband.
The defense noted that the injuries were known complications of the D&E procedure—a medically necessary intervention. They maintained that sound clinical judgment was exercised at all times.
- The jury returned a defense verdict.
After contracting Parvovirus, a 36-year-old woman suffered fetal demise at 23 weeks’ gestation. Cervical ripening was begun in preparation for a dilation and evacuation (D&E) of the fetal remains. The physician intended to continue this ripening the following morning, but the woman developed a fever and returned to the hospital later that evening.
The physician opted to conduct the D&E that night, but in the course of surgery perforated the woman’s uterus and delivered the bowel vaginally. As a result, the patient underwent a 5-hour procedure consisting of a hysterectomy with unilateral salpingo-oophorectomy, bowel resection, and colostomy.
The woman sued, claiming the surgeon was negligent in injuring her bowel. She further alleged lack of informed consent and improper preparation of the cervix. She argued that in addition to sterility and vaginal scarring, she suffers urinary and bowel incontinence. She maintained that resultant psychological injuries, psychosexual dysfunction, and physiological difficulties have led to problems in her sexual relationship with her husband.
The defense noted that the injuries were known complications of the D&E procedure—a medically necessary intervention. They maintained that sound clinical judgment was exercised at all times.
- The jury returned a defense verdict.
Were chart entries fabricated after woman bled to death?
Following a cesarean delivery and bilateral tubal ligation, a 43-year-old woman died due to hemorrhage.
Her husband, in suing, claimed his wife was left unattended for nearly 2 hours after surgery, during which time she bled to death. He questioned the validity of entries documenting 2 visits in that period, noting that the writing was unusually small and cramped, as if to fit under a later entry.
The defense claimed the chart was accurate and appropriate care administered.
- The case settled for $2.3 million.
Following a cesarean delivery and bilateral tubal ligation, a 43-year-old woman died due to hemorrhage.
Her husband, in suing, claimed his wife was left unattended for nearly 2 hours after surgery, during which time she bled to death. He questioned the validity of entries documenting 2 visits in that period, noting that the writing was unusually small and cramped, as if to fit under a later entry.
The defense claimed the chart was accurate and appropriate care administered.
- The case settled for $2.3 million.
Following a cesarean delivery and bilateral tubal ligation, a 43-year-old woman died due to hemorrhage.
Her husband, in suing, claimed his wife was left unattended for nearly 2 hours after surgery, during which time she bled to death. He questioned the validity of entries documenting 2 visits in that period, noting that the writing was unusually small and cramped, as if to fit under a later entry.
The defense claimed the chart was accurate and appropriate care administered.
- The case settled for $2.3 million.
Was patient not told of leiomyosarcoma tumor?
During a hysterectomy, a physician excised a tumor that a pathology report revealed to be a leiomyosarcoma confined to the uterus. The physician testified that he visualized the field but did not note any additional growths.
Six months later, the patient presented to her internist complaining of abdominal pain. A computed tomography scan demonstrated a large mass; exploratory surgery revealed leiomyosarcoma tumors. Despite chemotherapy and several surgical interventions, the patient died 21 months after the hysterectomy.
In suing, the woman’s family claimed the Ob/Gyn never informed the patient of the cancer’s presence—neither during her hospital stay nor at her 2-week or 6-week postsurgical examination. Further, it was noted that diagnostic studies that are appropriate following cancer resection were not ordered.
The defendant maintained he informed the patient and her husband that an aggressive cancer was removed; however, no notes indicated this conversation took place. The defendant further claimed that a gynecologic oncologist was consulted, but no notation of this was recorded, and the oncologist in question did not recall the alleged conversation.
- The plaintiff was awarded $1.7 million at mediation.
During a hysterectomy, a physician excised a tumor that a pathology report revealed to be a leiomyosarcoma confined to the uterus. The physician testified that he visualized the field but did not note any additional growths.
Six months later, the patient presented to her internist complaining of abdominal pain. A computed tomography scan demonstrated a large mass; exploratory surgery revealed leiomyosarcoma tumors. Despite chemotherapy and several surgical interventions, the patient died 21 months after the hysterectomy.
In suing, the woman’s family claimed the Ob/Gyn never informed the patient of the cancer’s presence—neither during her hospital stay nor at her 2-week or 6-week postsurgical examination. Further, it was noted that diagnostic studies that are appropriate following cancer resection were not ordered.
The defendant maintained he informed the patient and her husband that an aggressive cancer was removed; however, no notes indicated this conversation took place. The defendant further claimed that a gynecologic oncologist was consulted, but no notation of this was recorded, and the oncologist in question did not recall the alleged conversation.
- The plaintiff was awarded $1.7 million at mediation.
During a hysterectomy, a physician excised a tumor that a pathology report revealed to be a leiomyosarcoma confined to the uterus. The physician testified that he visualized the field but did not note any additional growths.
Six months later, the patient presented to her internist complaining of abdominal pain. A computed tomography scan demonstrated a large mass; exploratory surgery revealed leiomyosarcoma tumors. Despite chemotherapy and several surgical interventions, the patient died 21 months after the hysterectomy.
In suing, the woman’s family claimed the Ob/Gyn never informed the patient of the cancer’s presence—neither during her hospital stay nor at her 2-week or 6-week postsurgical examination. Further, it was noted that diagnostic studies that are appropriate following cancer resection were not ordered.
The defendant maintained he informed the patient and her husband that an aggressive cancer was removed; however, no notes indicated this conversation took place. The defendant further claimed that a gynecologic oncologist was consulted, but no notation of this was recorded, and the oncologist in question did not recall the alleged conversation.
- The plaintiff was awarded $1.7 million at mediation.
Uterine rupture follows failed VBAC attempt
A 39-year-old gravida with a previous cesarean delivery (due to twins) opted for a vaginal birth after cesarean (VBAC). She presented for induction of labor due to fetal macrosomia.
When the infant’s head was between -2 and-3 station, the fetal heart rate was noted to be nonreassuring. Medical staff initially believed this was due to normal changes within the second stage of labor, but when labor failed to progress over the next 25 minutes, the defendant physician was called.
The doctor ordered a cesarean delivery 20 minutes after his arrival; however, the procedure did not start until 20 minutes after that. In the interim, evidence of uterine rupture was noted, and the child’s heart rate fell into the 60s. The child suffered severe brain damage and cerebral palsy.
The plaintiffs claimed that had cesarean delivery been initiated at least 15 minutes earlier, neurologic injury might have been avoided.
The defendants denied the delay was unreasonable. Further, they maintained uterine rupture was a known complication of VBAC, and argued that the consent form signed by the mother explained the chance of uterine rupture and the risks associated with it.
- The jury awarded the plaintiffs $14.9 million.
A 39-year-old gravida with a previous cesarean delivery (due to twins) opted for a vaginal birth after cesarean (VBAC). She presented for induction of labor due to fetal macrosomia.
When the infant’s head was between -2 and-3 station, the fetal heart rate was noted to be nonreassuring. Medical staff initially believed this was due to normal changes within the second stage of labor, but when labor failed to progress over the next 25 minutes, the defendant physician was called.
The doctor ordered a cesarean delivery 20 minutes after his arrival; however, the procedure did not start until 20 minutes after that. In the interim, evidence of uterine rupture was noted, and the child’s heart rate fell into the 60s. The child suffered severe brain damage and cerebral palsy.
The plaintiffs claimed that had cesarean delivery been initiated at least 15 minutes earlier, neurologic injury might have been avoided.
The defendants denied the delay was unreasonable. Further, they maintained uterine rupture was a known complication of VBAC, and argued that the consent form signed by the mother explained the chance of uterine rupture and the risks associated with it.
- The jury awarded the plaintiffs $14.9 million.
A 39-year-old gravida with a previous cesarean delivery (due to twins) opted for a vaginal birth after cesarean (VBAC). She presented for induction of labor due to fetal macrosomia.
When the infant’s head was between -2 and-3 station, the fetal heart rate was noted to be nonreassuring. Medical staff initially believed this was due to normal changes within the second stage of labor, but when labor failed to progress over the next 25 minutes, the defendant physician was called.
The doctor ordered a cesarean delivery 20 minutes after his arrival; however, the procedure did not start until 20 minutes after that. In the interim, evidence of uterine rupture was noted, and the child’s heart rate fell into the 60s. The child suffered severe brain damage and cerebral palsy.
The plaintiffs claimed that had cesarean delivery been initiated at least 15 minutes earlier, neurologic injury might have been avoided.
The defendants denied the delay was unreasonable. Further, they maintained uterine rupture was a known complication of VBAC, and argued that the consent form signed by the mother explained the chance of uterine rupture and the risks associated with it.
- The jury awarded the plaintiffs $14.9 million.
Could timely appendectomy have prevented preterm birth?
Symptoms of nausea, vomiting, and right lower quadrant abdominal pain prompted a woman at 28 weeks’ gestation to present to a medical center. Her white blood cell count (WBC) was 22,700. After preterm labor was ruled out, the woman was given analgesics and sent home.
The following day the woman returned to the hospital, noting the same symptoms plus diarrhea. Her WBC at this time was 23,500. When no contractions were detected, the woman was given additional pain medication and again discharged home.
Two days after her last visit, she once again presented to the hospital, this time noting sharp pains. An appendectomy was then scheduled with a general surgeon. By this time, however, labor had begun and could not be stopped. The woman delivered the child, who suffers from cerebral palsy and spastic quadriparesis.
The mother claimed that the defendant either misread or failed to assess her WBC and clinical presentation. She argued that a gener-al surgeon should have been consulted during 1 of her initial 2 visits. Had an appendectomy been performed at that time, she claimed, she had a 90% chance of carrying the child to term.
The defendant maintained the standard of care was met at all times.
- The case settled for $2 million.
Symptoms of nausea, vomiting, and right lower quadrant abdominal pain prompted a woman at 28 weeks’ gestation to present to a medical center. Her white blood cell count (WBC) was 22,700. After preterm labor was ruled out, the woman was given analgesics and sent home.
The following day the woman returned to the hospital, noting the same symptoms plus diarrhea. Her WBC at this time was 23,500. When no contractions were detected, the woman was given additional pain medication and again discharged home.
Two days after her last visit, she once again presented to the hospital, this time noting sharp pains. An appendectomy was then scheduled with a general surgeon. By this time, however, labor had begun and could not be stopped. The woman delivered the child, who suffers from cerebral palsy and spastic quadriparesis.
The mother claimed that the defendant either misread or failed to assess her WBC and clinical presentation. She argued that a gener-al surgeon should have been consulted during 1 of her initial 2 visits. Had an appendectomy been performed at that time, she claimed, she had a 90% chance of carrying the child to term.
The defendant maintained the standard of care was met at all times.
- The case settled for $2 million.
Symptoms of nausea, vomiting, and right lower quadrant abdominal pain prompted a woman at 28 weeks’ gestation to present to a medical center. Her white blood cell count (WBC) was 22,700. After preterm labor was ruled out, the woman was given analgesics and sent home.
The following day the woman returned to the hospital, noting the same symptoms plus diarrhea. Her WBC at this time was 23,500. When no contractions were detected, the woman was given additional pain medication and again discharged home.
Two days after her last visit, she once again presented to the hospital, this time noting sharp pains. An appendectomy was then scheduled with a general surgeon. By this time, however, labor had begun and could not be stopped. The woman delivered the child, who suffers from cerebral palsy and spastic quadriparesis.
The mother claimed that the defendant either misread or failed to assess her WBC and clinical presentation. She argued that a gener-al surgeon should have been consulted during 1 of her initial 2 visits. Had an appendectomy been performed at that time, she claimed, she had a 90% chance of carrying the child to term.
The defendant maintained the standard of care was met at all times.
- The case settled for $2 million.
Myomectomy performed: Was hysterectomy indicated?
Narcotic analgesics failed to resolve the symptoms of a 32-year-old woman with menorrhagia, cramping, and pain. Her family physician therefore ordered a pelvic ultrasound. The study revealed multiple myomas, and the patient was referred to an Ob/Gyn.
In discussions with the Ob/Gyn, the patient expressed her desire for a hysterectomy to resolve the problem. During surgery, how-ever, the physician discovered that no fibroids existed within the uterus; rather, a large myoma on a stalk was attached to the patient’s uterus. The doctor opted to remove the fibroid at the stalk, leaving the uterus intact.
Following surgery, the patient’s symptoms continued. She sought treatment from several other physicians, and approximately 1 year after the initial procedure had a hysterec-tomy. She claims she is now symptom-free.
In suing, the plaintiff argued that her understanding of the initial procedure was that a hysterectomy would be performed, to ensure permanent resolution of her symptoms. She alleged that in opting for a myomectomy, the defendant conducted a surgery for which she had not given consent. She sought damages for pain and suffering, as well as lost wages.
The defendant claimed it was not necessary to inform the patient of changes in the planned surgery based on unsuspected pathology, and that the woman was told that additional procedures might be required.
- The jury returned a defense verdict.
Narcotic analgesics failed to resolve the symptoms of a 32-year-old woman with menorrhagia, cramping, and pain. Her family physician therefore ordered a pelvic ultrasound. The study revealed multiple myomas, and the patient was referred to an Ob/Gyn.
In discussions with the Ob/Gyn, the patient expressed her desire for a hysterectomy to resolve the problem. During surgery, how-ever, the physician discovered that no fibroids existed within the uterus; rather, a large myoma on a stalk was attached to the patient’s uterus. The doctor opted to remove the fibroid at the stalk, leaving the uterus intact.
Following surgery, the patient’s symptoms continued. She sought treatment from several other physicians, and approximately 1 year after the initial procedure had a hysterec-tomy. She claims she is now symptom-free.
In suing, the plaintiff argued that her understanding of the initial procedure was that a hysterectomy would be performed, to ensure permanent resolution of her symptoms. She alleged that in opting for a myomectomy, the defendant conducted a surgery for which she had not given consent. She sought damages for pain and suffering, as well as lost wages.
The defendant claimed it was not necessary to inform the patient of changes in the planned surgery based on unsuspected pathology, and that the woman was told that additional procedures might be required.
- The jury returned a defense verdict.
Narcotic analgesics failed to resolve the symptoms of a 32-year-old woman with menorrhagia, cramping, and pain. Her family physician therefore ordered a pelvic ultrasound. The study revealed multiple myomas, and the patient was referred to an Ob/Gyn.
In discussions with the Ob/Gyn, the patient expressed her desire for a hysterectomy to resolve the problem. During surgery, how-ever, the physician discovered that no fibroids existed within the uterus; rather, a large myoma on a stalk was attached to the patient’s uterus. The doctor opted to remove the fibroid at the stalk, leaving the uterus intact.
Following surgery, the patient’s symptoms continued. She sought treatment from several other physicians, and approximately 1 year after the initial procedure had a hysterec-tomy. She claims she is now symptom-free.
In suing, the plaintiff argued that her understanding of the initial procedure was that a hysterectomy would be performed, to ensure permanent resolution of her symptoms. She alleged that in opting for a myomectomy, the defendant conducted a surgery for which she had not given consent. She sought damages for pain and suffering, as well as lost wages.
The defendant claimed it was not necessary to inform the patient of changes in the planned surgery based on unsuspected pathology, and that the woman was told that additional procedures might be required.
- The jury returned a defense verdict.
Did inappropriate oxytocin cause uterine rupture?
A 30-year-old woman presented to a hospital in the early morning in labor with her first child; by phone, a physician ordered oxytocin administration.
The doctor instructed hospital staff to begin administration with 1 mU/min, with increases of 1 mU/min every 30 to 40 minutes. Despite this instruction, nurses increased the dose by 2 mU/min on 6 instances that day.
At approximately 1 PM, the physician performed an artificial rupture of membranes. At 5:30 PM, fetal monitoring revealed severe bradycardia; an emergency cesarean was performed 25 minutes later. Examination revealed uterine rupture. The child now suffers profound total-body spastic rigid cerebral palsy.
In suing, the plaintiffs noted that fetal monitoring strips showed decreased variability and repetitive late decelerations throughout the afternoon of delivery. They contended that the oxytocin dosage was increased on several occasions despite evidence of uterine hyperstimulation. Further, they claimed, the hyperstimulation resulted from inappropriate oxytocin administration.
The plaintiffs also argued that the Ob/Gyn should have noted dosing instructions were not being followed when she saw the patient at 1 PM; further, during a 4 PM phone call, the physician should have inquired as to the strength and frequency of contractions.
The doctor maintained it was the staff’s responsibility to carry out dosing orders as indicated and to inform the physician of any abnormalities in the labor.
The defendant hospital claimed that nurses are often called on to use discretion in dose increases, and that their actions were reasonable. Further, it was alleged, no clear indication of uterine hyperstimulation was present and abnormalities on the fetal monitoring strips were temporary. The hospital maintained the mother’s inherently weak uterus, not inappropriate oxytocin, was to blame for the rupture.
- The case settled for $4 million at mediation.
A 30-year-old woman presented to a hospital in the early morning in labor with her first child; by phone, a physician ordered oxytocin administration.
The doctor instructed hospital staff to begin administration with 1 mU/min, with increases of 1 mU/min every 30 to 40 minutes. Despite this instruction, nurses increased the dose by 2 mU/min on 6 instances that day.
At approximately 1 PM, the physician performed an artificial rupture of membranes. At 5:30 PM, fetal monitoring revealed severe bradycardia; an emergency cesarean was performed 25 minutes later. Examination revealed uterine rupture. The child now suffers profound total-body spastic rigid cerebral palsy.
In suing, the plaintiffs noted that fetal monitoring strips showed decreased variability and repetitive late decelerations throughout the afternoon of delivery. They contended that the oxytocin dosage was increased on several occasions despite evidence of uterine hyperstimulation. Further, they claimed, the hyperstimulation resulted from inappropriate oxytocin administration.
The plaintiffs also argued that the Ob/Gyn should have noted dosing instructions were not being followed when she saw the patient at 1 PM; further, during a 4 PM phone call, the physician should have inquired as to the strength and frequency of contractions.
The doctor maintained it was the staff’s responsibility to carry out dosing orders as indicated and to inform the physician of any abnormalities in the labor.
The defendant hospital claimed that nurses are often called on to use discretion in dose increases, and that their actions were reasonable. Further, it was alleged, no clear indication of uterine hyperstimulation was present and abnormalities on the fetal monitoring strips were temporary. The hospital maintained the mother’s inherently weak uterus, not inappropriate oxytocin, was to blame for the rupture.
- The case settled for $4 million at mediation.
A 30-year-old woman presented to a hospital in the early morning in labor with her first child; by phone, a physician ordered oxytocin administration.
The doctor instructed hospital staff to begin administration with 1 mU/min, with increases of 1 mU/min every 30 to 40 minutes. Despite this instruction, nurses increased the dose by 2 mU/min on 6 instances that day.
At approximately 1 PM, the physician performed an artificial rupture of membranes. At 5:30 PM, fetal monitoring revealed severe bradycardia; an emergency cesarean was performed 25 minutes later. Examination revealed uterine rupture. The child now suffers profound total-body spastic rigid cerebral palsy.
In suing, the plaintiffs noted that fetal monitoring strips showed decreased variability and repetitive late decelerations throughout the afternoon of delivery. They contended that the oxytocin dosage was increased on several occasions despite evidence of uterine hyperstimulation. Further, they claimed, the hyperstimulation resulted from inappropriate oxytocin administration.
The plaintiffs also argued that the Ob/Gyn should have noted dosing instructions were not being followed when she saw the patient at 1 PM; further, during a 4 PM phone call, the physician should have inquired as to the strength and frequency of contractions.
The doctor maintained it was the staff’s responsibility to carry out dosing orders as indicated and to inform the physician of any abnormalities in the labor.
The defendant hospital claimed that nurses are often called on to use discretion in dose increases, and that their actions were reasonable. Further, it was alleged, no clear indication of uterine hyperstimulation was present and abnormalities on the fetal monitoring strips were temporary. The hospital maintained the mother’s inherently weak uterus, not inappropriate oxytocin, was to blame for the rupture.
- The case settled for $4 million at mediation.
Vacuum suction blamed for severe retardation
During the course of delivery, a physician applied vacuum suction to a male child’s head 15 times. The child was born with cerebral palsy and severe mental retardation, with an estimated IQ of 25.
In suing, the plaintiff alleged that the suction caused constriction of internal veins, thus cutting off blood supply to the child’s brain.
The defense, noting a slightly elevated temperature in the mother during labor, maintained that the neonate’s injuries stemmed from a maternal condition.
- The judge awarded the plaintiff $19 million.
During the course of delivery, a physician applied vacuum suction to a male child’s head 15 times. The child was born with cerebral palsy and severe mental retardation, with an estimated IQ of 25.
In suing, the plaintiff alleged that the suction caused constriction of internal veins, thus cutting off blood supply to the child’s brain.
The defense, noting a slightly elevated temperature in the mother during labor, maintained that the neonate’s injuries stemmed from a maternal condition.
- The judge awarded the plaintiff $19 million.
During the course of delivery, a physician applied vacuum suction to a male child’s head 15 times. The child was born with cerebral palsy and severe mental retardation, with an estimated IQ of 25.
In suing, the plaintiff alleged that the suction caused constriction of internal veins, thus cutting off blood supply to the child’s brain.
The defense, noting a slightly elevated temperature in the mother during labor, maintained that the neonate’s injuries stemmed from a maternal condition.
- The judge awarded the plaintiff $19 million.