Page 43 - OB Risks - Delivering the Goods (Part One)

SVMIC Obstetrics Risks: Delivering the Goods

C A S E S T U DY

A 36-year-old gravida 3, para 1, at 36 weeks gestation
with a history of a previous miscarriage, diabetes mellitus,

and morbid obesity was admitted with nausea, vomiting,
abdominal cramps, and decreased fetal movement noted

for two days. The patient was followed by her primary care
doctor for her prenatal care, so the initial phone call that

was made after the patient’s arrival was to the covering
obstetrician for labor and delivery. During that call, the

nurse indicated there were no issues with the fetal heart
tracings and no detected contractions. Four hours later,

the nurse called revealing that she had concerns with the
variability because “it was not as good as she would like”.

The nurse documented the fetal heart tracings as “minimal
variability at best with no accelerations”. After four more

hours, no fetal heart rate was detected. The nurse notified
the obstetrician, who ordered a stat bedside ultrasound

which revealed fetal demise. The infant was delivered
with a double nuchal cord and a true knot.

In the lawsuit that followed, the plaintiff asserted the nurse

failed to use standard nomenclature when discussing the
fetal heart tracing with the obstetrician. It was also asserted
that the physician failed to ask enough questions to obtain

specific information related to the patient’s history and

medical condition, the fetal status, as well as a specific
interpretation of the fetal heart tracings. The plaintiff
further alleged the obstetrician should have come to the

hospital to evaluate the patient when the nurse indicated

that the variability was “not as good as she would like”

Page 43