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Management of labour and delivery of baby with shoulder dystocia (06HDC02099)
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(06HDC02099, 28 September 2007)
Obstetric registrar ~Midwife ~
District health board ~ Shoulder dystocia ~ Fetal distress ~
Non-reassuring CTG ~ Pain relief ~ Care plan ~ Information about
transfer ~ Right 4(1)
A couple complained about the
adequacy and appropriateness of the antenatal and intrapartum care
provided to them by a lead maternity carer midwife (LMC), an
obstetric registrar, and a public hospital, and the adequacy of the
information provided to them about labour options, including
epidural anaesthesia for pain relief.
The couple's baby was born severely
compromised following a Ventouse delivery for shoulder dystocia.
There was some cardiotocograph (CTG) evidence that the obstetric
registrar missed signs of fetal compromise some time before
delivery. At birth the baby had the cord wound tightly around her
It was held that shoulder dystocia
could not have been predicted and that the obstetric registrar
managed the unexpected situation appropriately. The decision to
proceed with a vaginal delivery was an appropriate clinical
The exercise of reasonable care and
skill in reading a CTG is an important aspect of good care by an
obstetrician. In this case, considering other factors such as the
very slow progress and prolonged labour, further investigation was
needed. It was held that the obstetric registrar failed to exercise
reasonable care and skill and breached Right 4(1) in this aspect of
his obstetric management.
The midwife was found to have
provided appropriate care and information, and the District health
board was found not vicariously liable for the obstetric
registrar's breach of the Code.
The report contains comments about
midwifery care plans, provision of information about epidural
anaesthesia, and the use of pagers in hospital.
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