Page 23 - OB Risks - Delivering the Goods (Part Two)

SVMIC Obstetrics Risks: Delivering the Goods

was not felt to be in active labor and was discharged at
3:52 am.

On September 28 , the patient returned to the hospital at
th
3:23 pm complaining of increasing pain. The cervix again

was unchanged though the presenting part was noted
to be at zero station as it was on her initial labor and

delivery visit. The blood pressure was noted to be 159/94
at that time. The patient was monitored. She did not make

changes in her cervix over this interim time and continued
to have painful contractions. Several phone calls were

made to the same on-call OB during these three separate
visits to the hospital, but he did not come in. Apparently,

there was a change of coverage at approximately 7:00
pm when another on-call OB took over call coverage.

There was noted to be spontaneous rupture of membranes

at 7:11 pm. The cervix was unchanged at that time and
the patient continued to have elevated blood pressures

throughout the evening. Because of the patient’s pain,
an epidural was recommended via telephone by the

covering OB at 7:38 pm. He also stated at that time by
telephone that he would consider a VBAC as opposed to

a C-section. There was noted to be a change in the fetal
heart tracing with multiple variable decelerations noted

along with minimal to absent beat-to-beat variability.
No change was noted in the cervical evaluation and an

epidural was placed at 9:16 pm with no apparent difficulty,
and the patient became more comfortable at that time.

The next significant change occurred at 11:08 pm at which
time there with a sudden decrease in the fetal heart

tracing into the 70s. The patient had her position changed,

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