Labor & Delivery, Pitocin, Fetal Monitors: Court Finds Evidence Of  Nursing Negligence.

Legal Eagle Eye Newsletter for the Nursing Profession

Request a complimentary copy of our current issue. 

 

  The patient's nursing expert explained that the Pitocin drip is usually controlled by the labor and delivery nurse.

  It is increased to increase contractions and decreased or stopped altogether if the contractions get too strong, too long or too close together.

  The Pitocin is to be adjusted based on whether the baby's fetal heart tracings are reassuring or non-reassuring.  It is only increased if the tracings are reassuring.

  The nursing experts' review of the chart revealed that the tocotransducer which identifies the beginning and end of each of the mothers contractions was not working for the first three hours after the mother was admitted to the labor and delivery unit.

  There were also numerous intervals evident from the fetal monitor tracings of non-reassuring tones that should have been but were not reported.

  If the physician had been notified of the non-reassuring tones a cesarean could have been done early on to save the child from brain damage. COURT OF APPEALS OF TEXAS November 29, 2012

  The mother was admitted to the labor and delivery unit at 10:10 p.m. for induction of labor. 

  The baby was delivered vaginally at 5:27 p.m. the next afternoon with the umbilical cord around her neck.  She did not start breathing on her own for almost seven minutes and then began having seizures. 

  A pediatric neuroradiologist, who performed ultrasound scans on the child's brain and who would later submit an expert report for the family in their lawsuit against the hospital, related the child's problems to asphyxia consistent with bradycardic events prior to her delivery.

  The Court of Appeals of Texas accepted reports prepared by the family's experts, an ob/gyn physician, a labor and delivery nurse and the pediatric neuroradiologist which pointed directly at the negligence of the labor and delivery nurses.

Familys Medical Expert

  When Cytotec has been used for cervical ripening followed by IV Pitocin for induction of labor, the labor and delivery nurses have the responsibility to maintain readable tracings of the fetal heart tones and the maternal contraction patterns.  The nurses should not start or continue Pitocin when there are non-reassuring fetal heart tracings, when the contractions cannot be monitored or with uterine hyperstimulation.  The physician must be notified of non-reassuring fetal heart tracings.

Familys Nursing Expert

  When Pitocin is in use the nurse must see to it that the equipment that monitors uterine contractions is recording the mother's contractions, the family’s nursing expert said. 

  Review of the fetal heart monitor tracings showed several lengthy intervals of non-reassuring heart rates. The records further revealed that a nurse increased the Pitocin even with late decelerations with decreased variability, until it was eventually decreased and then stopped a few hours before birth by a different nurse, but then restarted again until the birth with ominous tracings showing on the monitor.  Med. Ctr., __ S.W. 3d __, 2012 5951982 (Tex. App., November 29, 2012).