Whitby mother arrived to deliver her first child after being cared for by her family doctor and an obstetrician. At the Ajax area hospital, a fetal heart rate (FHR) monitor strip was attached, as her membranes had ruptured several hours earlier. The FHR strip was running at 1 cm per hour instead of the usual 3 cms per hour, making the strip difficult to interpret. Blood work showed a moderate neutrophilia, indicating a possible bacterial infection. The obstetrician received telephone instructions to begin Oxytocin, but afterwards Mom remained unchanged at 1cm dilated and spines at -3, meaning the baby’s head was not positioned for delivery. A very high dosage of Oxytocin, in increasing amounts, was ordered and given to Mom throughout the day. The nurse noticed an FHR drop at one point and lowered the infusion rate, at which point the doctor had yet to examine Mom. This was done despite concerns that the presenting part was not cephalic (the baby was in the wrong position for delivery) and that the Oxytocin had in fact failed to induce labour.
After her second night in the hospital, Mom was still only 3-4 cm dilated and the fetal head was too high for delivery. Ampicillin was given, which was contrary to protocol (protocol dictates that this should have been done 18 hours after her membranes ruptured). In the late afternoon, the doctor asked Mom to walk around, despite the fact that inductions should not be stopped after they are begun without a legitimate reason, and that they should be monitored very closely, especially given Mom’s slow progression. The FHR monitor was stopped to allow her to walk around. An epidural was given and the monitor was replaced an hour later. The monitor began to show a sinusoidal pattern (a wave-like pattern with poor variability between beats). Mom’s temperature rose to 38.1 degrees, there was a delay in paging the doctor and the paediatrician did not arrive until half an hour later.
The baby was born via Caesarean section and required bag and mask resuscitation. He began to show seizure and apnea activity, but no cord blood was taken. Perinatal asphyxia secondary to hypoxic ischemic encephalopathy was diagnosed. The baby developed spastic quadriplegic cerebral palsy, epilepsy and profound cognitive impairment.
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