Wellstar North Fulton amended complaint alleges delayed cesarean before newborn’s brain injury after uterine rupture
The amended complaint alleges that a hospital and an obstetric practice allowed a trial of labor after cesarean. Wellstar’s 2019 policy required the full surgical team to be “immediately available,” replacing a 2017 policy that required the team to be “in-house.” During a daylong labor, nurses saw excessive contractions and unrelieved breakthrough pain but did not call the assigned obstetrician. The fetal heart tracing later showed diminishing variability and worsening decelerations while a nurse increased Pitocin. When the fetal heart rate dropped into the 80s, the assigned obstetrician was still not at the hospital. Another physician performed the emergency cesarean about twenty-four minutes after nurses recognized a physician was needed, and the delivery revealed a ruptured uterus. The newborn received a preliminary diagnosis of a hypoxic-ischemic brain injury.
Overview
This page concerns a public complaint alleging that a physician was not immediately available during a trial of labor after cesarean. The delay preceded an emergency cesarean performed after the uterus ruptured.
Chronology
The complaint alleges as follows:
- The patient was admitted to Wellstar North Fulton Hospital to attempt a trial of labor after a prior cesarean; her physician was not there.
- Her contractions became excessive during the day and she reported severe breakthrough pain in the afternoon, but nurses did not notify her doctor.
- By early evening a nurse started and later increased Pitocin while the fetal heart tracing showed diminishing variability and worsening decelerations.
- At 6:38 p.m. the fetal heart rate dropped into the 80s, which the complaint describes as a “stat” emergency.
- Nurses called the midwife, who called the assigned obstetrician. The obstetrician was not at the hospital when nurses moved the patient to the operating room.
- Another physician arrived and began the emergency cesarean about twenty-four minutes after nurses recognized a physician was needed, and the delivery revealed a ruptured uterus.
- The newborn was born not breathing and received a preliminary diagnosis of hypoxic-ischemic encephalopathy.
Alleged failures
The complaint alleges the following failures:
- The hospital did not require physicians to remain in the hospital during a trial of labor after cesarean, as the complaint says “immediately available” requires.
- Nurses did not recognize the tachysystole, unrelieved breakthrough pain, and worsening fetal heart tracing as warning signs of uterine rupture.
- Nurses and midwives did not call the obstetrician earlier or use the chain of command when the fetal heart rate worsened.
- The hospital and the medical practice knew or should have known of a similar uterine-rupture injury during an earlier trial of labor at the hospital.
- The complaint pleads professional negligence, ordinary negligence, and gross negligence, and attaches an expert affidavit under O.C.G.A. § 9-11-9.1.