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Complications During Induced Labor Result in Newborn’s Death | Port Orange Child Injury Attorney

Complications During Induced Labor Result in Newborn’s Death

An induced labor complicated by a ruptured uterus and fetal compromise resulted in a severely oxygen deprived newborn who died three days after birth.

This healthy mother, 32, with no known allergies, entered Labor and Delivery for induction at 40 weeks. The woman had a McDonald’s cerclage at 14 weeks to close up her cervix, which was removed by her obstetrician at 36 weeks.

Her obstetrician scheduled an induction of labor (the reason for this was unkown). Examination in Labor and Delivery revealed that her cervix was 1cm dilated. Pitocin was ordered to induce labor, and the obstetrician attempted rupture of amniotic membrane on three separate occasions over six hours without success.

The fetal heart rate (FHR) tracing was reactive throughout the day. Pitocin was stopped in the late afternoon because the woman’s cervix did not dilate. She was sent home with plans to return in a few days. Six days later, the woman returned for a second induction.

At 9 a.m. her cervix was 1-2cm and long, and the FHR had mild-moderate variability. with a baseline of 140-150 beats per minute (bpm). Prostin gel was placed to ripen the cervix and Pitocin started “per protocol.” Three and a half hours later, her cervix was 2-3cm dilated and the FHR tracing had moderate variability with occasional variable decelerations.

An hour later she received an epidural for pain relief, and her cervix was about 4cm dilated. Her amniotic fluid sac ruptured spontaneously and a “small amount, blood-tinged” fluid was noted. Ninety minutes later, her cervix was 5cm dilated, the FHR was 140bpm with minimal variability and variable decelerations around the time of contractions.

Four hours later, her cervix was 8cm dilated and the fetal head at 1+/2+ station. The FHR was 160-170bpm with minimal variability and variable decelerations, some with slow return to baseline. The woman complained of left-sided pain and her epidural was reinforced.

Two hours later, the FHR baseline was 170bpm with deep decelerations. An intrauterine pressure catheter was used to record contractions. The woman complained of severe pain and a fetal scalp electrode was applied.

Thirty-five minutes later, there was no cervical change. The FHR was 170bpm with deep decelerations. The obstetrician decided to deliver by cesarean section.

A female infant was found free-floating in the abdomen, requiring resuscitation. The mother’s uterus and bladder had ruptured. The infant was severely asphyxiated with extensive neurologic injury, and died at three weeks.

This case was settled for $750,000 against the obstetrician for negligent care during labor and delivery

The parents had a strong case based on the following factors:

No clear reason for early induction or labor. The reason for inducing labor prior to the baby’s due date, especially with an unripe cervix, was unclear and undocumented.

Delay in diagnosis and treatment of deteriorating fetal status. According to the American College of Obstetrics and Gynecology, FHR tracings that begin with moderate variability and progress to minimal or no variability with persistent deepening decelerations are signs of deteriorating fetal status and require evaluation.

Failure to perform a cesarean section in a timely fashion. The obstetrician could not explain why he didn’t respond to the deteriorating FHR pattern, and the nurse involved in this delivery did not convey her concerns about the FHR tracings.

Delivery team not prepared for complications. Several factors contributed to the uterine rupture during labor, including the lacerated and scarred cervix that prevented normal dilation in response to labor contractions, and the integrity of cervical tissue at the laceration site. A scheduled induction should have given the care team maximum opportunity to review the chart and be alert for such risks.

Lack of documentation of informed consent. The woman said she was not informed about the risks and benefits of induction of labor. Informed consent involves a series of discussions that should include the rationale for the procedure or treatment, risks involved, expected benefits and alternatives to treatment or no treatment.

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