Legal Briefs: Tachysystole, Uterine Rupture, and a Bad Outcome.

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EDITOR’S NOTE The Legal Briefs feature is based on actual malpractice cases with opinions of the plaintiff and defense physician experts interspersed throughout the case. The format of this feature does not provide evidence that supports or refutes each of these opinions. A 30-year-old gravida 3, para 1 woman presented at 41 weeks’ gestation for induction of labor. The pregnancy had been unremarkable. Two years before this pregnancy, the woman had undergone a cesarean after protracted labor that resulted in the delivery of a term healthy infant. For this pregnancy, a decision to induce labor and have a trial of labor after cesarean was agreed upon by the woman and her obstetrician. Increasing amounts of oxytocin were administered. Nine hours after induction was started, her contractions dramatically increased in frequency. The intervals between the peak of contractions varied between 60 and 90 seconds and the time between the end of one contraction and the beginning of the next was less than 1 minute in most cases. Long periods of tachysystole emerged. The obstetrician retained by the plaintiff stated that the treating obstetrician was required to decrease or discontinue the oxytocin when the contractions became too frequent. He explained that the time between the peak of one contraction and the next contraction needed to be at least 2 minutes and the interval between the end of one contraction and the beginning of the next needs to be at least 1 minute. He pointed out that these intervals were not maintained. He further explained that fetal gas exchange occurs during the rest phase between contractions and therefore, without proper rest intervals, gas exchange will eventually be compromised. He further pointed out that even the definition of tachysystole was met multiple times. He explained the definition of tachysystole was more than 5 contractions …