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Continued from Page 1
At 2:06 p.m. another one of the obstetricians from the same group,
defendant obstetrician #2, who happened to be in the hospital,
was requested to install the internal uterine monitor, did so,
and then left to perform another delivery. The internal monitor
did not work properly, so the nurse in attendance did not have
reliable information about the uterine activity. At that same
time the mother was having some unusual pain, even though she
had had epidural analgesia. More importantly, an adequate labor
pattern had been established by 2:00 p.m.-cervical dilatation
had progressed from four centimeters to six centimeters in the
forty minutes between 1:20 and 2:00 p.m. Notwithstanding the fact
that the uterine monitor was not working, the patient was having
unusual pain, and an adequate labor pattern had been established,
the nurse increased the pitocin again at 2:14 p.m. Within a few
minutes of the last increase of pitocin the fetal heart rate pattern
changed to the point where the nurse became concerned and wanted
an obstetrician to evaluate the patient. However, obstetrician
#1 was across town in the office, and obstetrician #2 was still
in the hospital occupied with another delivery. As a result it
took from 2:31 until 2:44 p.m. to get obstetrician #2 back into
the room to see the mother.
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By then the fetal heart rate had dropped from an average of 160
beats per minute down into the 8 to 90 beat per minute range (see
graphic). This is called a prolonged severe deceleration or bradycardia.
All of the experts, including the defense experts, agreed that,
in the presence of such a pattern, given the existence of the
uterine scar, and the use of pitocin, obstetrician #2 should have
considered uterine rupture and also a possible placental abruption
as part of the differential diagnosis. Both represent extreme
obstetric emergency conditions requiring the most rapid delivery
possible. Unfortunately, these possibilities never entered obstetrician
#2's mind. Instead of immediately mobilizing for a possible cesarean
section and then evaluating the patient, obstetrician #2 spent
the next 15 minutes ordering position changes, finally turning
the pitocin off at 2:47 p.m., and watching, waiting, and hoping
that the fetal heart rate pattern would improve. A cesarean section
was finally ordered at 2:59 p.m. and Trevor was delivered at 3:13
p.m. Everybody in the delivery room was shocked and surprised
when the incision was made and Trevor was found to have extruded
through the opening in the uterus at the previous ce-sarean section
scar site into the abdominal cavity.
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Hospital policies and procedures were in place covering the important
subject of resuscitators in the delivery room for management of
the newborn. All of the witnesses agreed that, given the ominous
fetal heart pattern, this was a high risk situation and everybody
involved should have anticipated a depressed infant likely to
need expert resuscitation. Hospital policy in such circumstances
appropriately called for a team of three resuscitators, including
the neonatal intensive care unit registered nurse/intubator, a
neonatal nurse practitioner, and a physician resuscitator. Unfortunately
for Trevor, the only one called or present at the time of his
delivery was the neonatal nurse practitioner, who had no personal
experience as the primary resuscitator for an infant as depressed
as Trevor, and who was unable to intubate Trevor after two attempts.
It was not until the anesthesiologist was called away from the
mother's bedside to intubate Trevor that this was successfully
accomplished, approximately
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