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News: Plaintiffs alleged that hospital nurses inappropriately administered Pitocin and caused insufficient blood flow and oxygenation to the placenta prior to delivery and that the obstetrician failed to recognize and respond to fetal distress. When the child was born, APGAR scores were low, and the child required extensive resuscitation.
Background: The mother sued the hospital and obstetrician. The plaintiffs alleged that the hospital's labor and delivery nurses negligently administered excessive amounts of Pitocin to the full-term mother during labor in violation of the hospital's policies and procedures. The plaintiffs claimed that the dosage and frequency were excessive in relationship to length and strength of the contractions.
Administration of the drug resulted in uterine hyperstimulation, causing utero/placental insufficiency and hypoxia, the plaintiffs charged. Further, they claimed that the obstetrician failed to detect signs of fetal distress as indicated by the fetal heart monitor and that a cesarean delivery should have been performed. The child, who was born with low APGAR scores, required extensive resuscitation after delivery.
The hospital maintained that the Pitocin was properly administered to augment labor and that nursing personnel did not act negligently. The hospital also asserted that if negligence was found against the hospital, the obstetrician should have noticed the change in the fetal heart rate monitor and delivered the child by cesarean. The obstetrician claimed that the heart rate monitor did not indicate the child was in distress because there was no late deceleration but instead variable decelerations with a late component. The obstetrician also asserted that it would have taken just as long to perform a cesarean, and the reduction in blood flow caused by uterine hyperstimulation from the Pitocin was unavoidable.
What this means to you: The first red flag in this case is the fact that it seems the Pitocin procedures and protocols either were not followed in this case or staff was not familiar with them, says Bucky Jones, RN, BSN, LHCRM, manager of the department of risk management at Tampa General Healthcare. "In order for protocols and procedures to be of use, staff must be regularly advised and educated as to what to do. And, for all protocols involving drugs, they should be regularly reviewed and updated by pharmotherapists and should always include reversing agents, if available," she says.
Further, Jones notes that "the condition of the fetal monitor strips is unclear. Protocols should include the appropriate chain of command with regard to who is notified when questions arise on monitoring results. Protocols should clearly indicate the order of notification, whether it is additional nursing staff and supervisors and/or the attending physician, when questions arise with patient monitoring."
The second red flag in this incident is that the hospital implicated its codefendant, the obstetrician, she says. "As a general rule, you never point a finger at the other defendants, even in situations where the heat is on," she adds.
Anonymous v. Anonymous, Santa Anna County California Superior Count.