On 1/24/2014 a 21-year-old female presented to a hospital with spontaneous rupture of membranes and meconium-stained amniotic fluid at about thirty-nine weeks of pregnancy.
Upon admission, the patient was placed on a fetal monitor, which documented variable decelerations of the fetal heart rate. In response to the monitor tracings, an obstetrician ordered the administration of intravenous fluids. Shortly thereafter, the obstetrician ordered the performance of an amnioinfusion.
Over the next couple of hours, the fetal monitor began documenting recurrent late fetal heart rate decelerations and loss of fetal heart rate variability, indicative of probable insufficient fetal oxygenation. The obstetrician was notified of the recurrent late fetal heart rate decelerations and loss of fetal heart rate variability.
In response to the monitor tracings, the obstetrician ordered the rate of IV fluid administration increased. Despite the monitor tracings indicating probable fetal distress, the obstetrician did not diagnose, or did not document diagnosing, fetal intolerance to labor and allowed the trial of labor to continue.
At some point in time between 6:15 p.m. and 7:30 p.m., the obstetrician decided to manage the trial of labor from outside of the hospital. Based on the patient’s presentation, the obstetrician should have continued to manage the trial of labor, in person, at the hospital. The fetal monitor continued to document recurrent late fetal heart rate decelerations and a loss of fetal heart rate variability over the next several hours. The obstetrician was notified of the recurrent late fetal heart rate decelerations and loss of fetal heart rate variability on multiple occasions during that time span. Despite the monitor tracings indicating probably continued fetal distress, the obstetrician did not promptly return to the hospital to deliver the baby.
Shortly after midnight on 12/25/2014, the obstetrician was again notified of the recurrent late fetal heart rate decelerations and loss of fetal heart rate variability. At 1:28 a.m., the obstetrician returned to the hospital, presented to the delivery room, and shortly thereafter delivered the baby.
The baby was in full cardiac arrest at the time of delivery. Efforts to resuscitate the baby were abandoned after about 20 minutes. The final diagnosis was stillborn.
The obstetrician did not dictate or write any progress notes during the trial of labor.
The Board judged the obstetrician’s conduct to be below the minimum standard of competence given that she failed to diagnose fetal intolerance to labor, manage the trial of labor, in person, at the hospital, and promptly return to the hospital and deliver the baby upon receiving continued reports of probably fetal distress.
The Board ordered that the obstetrician pay a fine of $5,000 against her license and pay reimbursement costs for the case at a minimum of $3,949.77 and not to exceed $5,949.77. The Board also ordered that the obstetrician complete five hours continuing medical education in the area of obstetric medicine and five hours of continuing medical education in “Risk Management.”
Date: November 2017
Diagnosis: Obstetrical Complication
Significant Outcome: Death
Case Rating: 2
Link to Original Case File: Download PDF
← Back to the search results