Manitowac county (Wis) Circuit court—A gravida presented to a hospital at term for induction of labor. The woman was placed on 56 mU of oxytocin and, after 18 hours, the cervix completely dilated. During that time, the nurse twice reduced the oxytocin due to concerns about decreasing variability in the fetal heart rate. However, the Ob/Gyn instructed the nurse to resume induction and let labor continue. The nurse then withdrew the oxytocin when late decelerations developed. Eventually, the decelerations disappeared and variability improved.
Early the next morning, the physician assessed the patient and noted that the fetal station was +1, the baby’s head was occiput posterior, and the mother had a narrow pubic arch. He attempted a vacuum delivery. After 20 minutes with only minimal progress and some rotation, he switched to forceps, delivered the fetal head, and encountered shoulder dystocia.
At birth, the baby was hypotonic and needed to be resuscitated, and her Apgars were 0 and 3. A 3-month MRI showed bilateral symmetrical basal ganglia damage. The child has severe cerebral palsy and spastic quadriparesis and needs a feeding tube.
In suing, the parents argued that the attempted rotation with the vacuum caused cord compression and deprived the fetus of adequate oxygen. The physician claimed he was using the + or -3 classification system for the station of the fetal head, asopposed to the + or -5 system. Therefore, he stated, his decision to opt for vacuum delivery when the fetal head was at +1 was within the standard of care.
The case settled before trial for $3.5 million.
The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts. While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.