Case Studies – Labor and Delivery

The Texas case involved a nurse whose inappropriate act led to the delivery of an asphyxiated child. This asphyxiation is attributed to a bradycardic event characteristic of prolonged delays in the delivery process. The nurse’s negligent act, as revealed by the family’s medical and nursing experts, was the failure of the nurse to notify the physicians of the non-reassuring heart rates upon administration of Cytotec and Pitocin. Cytotec has been utilized in cervical ripening in the labor induction process. Its simultaneous use with Pitocin causes cervical ripening and uterine contractions that ultimately cause the expulsion of the fetus (West et al., 2017). Upon their utilization, it is fundamental to monitor for readable fetal tones and report as assuring or non-reassuring. The caesarian section is informed by non-reassuring fetal heart tracings, something that the nurse failed to observe. Instead, the nurse increased the Pitocin dose even with these findings.

In the Mississippi case, a thirty-one-year-old diabetic had a complete uterine rupture and separated placenta upon delivery by a caesarian section. These events are attributable to the prolonged stay of the fetus before delivery. The reason for the prolonged stay, however, was the lack of observable cervical dilation upon examination by both the nurse and the obs. /GYN. Additionally, there were no fetal heart tones observable on the monitor. The absence of fetal heart tones, lack of cervical dilation, and the woman’s history often indicate that the individual is not in labor. This may sometimes indicate an emergency requiring a cesarian section (Kakoma, 2016). In this case, as the labor and delivery nurse confirmed, the mother was not in labor. However, the abdominal pain characteristic of labor and evident in the morning required prompt physician’s address, and his delay led to these events.

In both cases, there was an adverse event. In the Texas case, the event was an asphyxiated child, while in the Mississippi case, the event was a ruptured uterus. Whereas the Texas cases directly implicated the nurse, with evidence pointing to her negligence as an attributing factor to these events, the Mississippi case didn’t result from the nurse’s action. The nurse’s assessment of the absence of labor was correct.

References

Kakoma, J. (2016). Cesarean section indications and anthropometric parameters in Rwandan nulliparae: preliminary results from a longitudinal survey. Pan African Medical Journal, 24. https://doi.org/10.11604/pamj.2016.24.310.9603

West, H., Jozwiak, M., & Dodd, J. (2017). Methods of term labor induction for women with a previous cesarean section. Cochrane Database Of Systematic Reviews. https://doi.org/10.1002/14651858.cd009792.pub3

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