Page 27 - OB Risks - Delivering the Goods (Part Two)

SVMIC Obstetrics Risks: Delivering the Goods

C A S E S T U DY

A 24-year-old gravida 2, para 1, with a prior C-section

presented to her OB on January 7 , and at that visit, her
th
estimated due date was established as May 11 . Medication
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was started for hypertension, and per the records entry
on that date, the patient stated that she wanted a vaginal

delivery. The patient had routine follow-up visits over the
next several months. On April 1 , the patient presented
st
for her follow-up visit and again expressed her desire to
have a vaginal birth after cesarean, according to the chart.

The note also stated that possible complications were
discussed at length including the possibility of uterine

rupture.

On May 3 , the patient was seen and monitored at the
rd
hospital for “onset of labor”. A fetal monitor was started at
8:57 am and continued until 2:12 pm. She received Tylenol

#3 and was discharged. She returned at 9:45 pm and was

eventually admitted in labor.

On May 4 at 2:20 am, she received an epidural and at 2:41
th
am, Pitocin was started. At 8:29 am, her blood pressure
was noted to be 189/115 with a pulse of 114. There were

numerous elevated blood pressures as documented
in the chart and on her strips as well, but there was no

documentation that any of these elevated blood pressures
were reported to the on-call physician. At 8:35 am, the

OB was paged through the exchange and the nurse’s
notes state that he was also paged again at 8:41 am. The

nurse’s notes further documented that at 8:47 am the
fetal monitor was picking up maternal pulse. At 8:57 am,

the OB returned call and stated he was “on his way”. At

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