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Management of ventouse-assisted birth (06HDC12769)
Download Management of ventouse-assisted birth (06HDC12769) (PDF 41Kb)
(06HDC12769, 6 August 2008)
Obstetrician ~ Gynaecologist ~
Vaginal delivery ~ Ventouse ~ Avulsion of umbilical cord ~
Registration ~ Recruitment ~ Malpractice claims ~ Reference checks
~ Medical council ~ Scope of practice ~ Induction ~ Labour ~
Misleading clinical records ~ Pain relief ~ Transfer of care ~
Informed Consent ~ Supervision ~ Bullying ~ Rights 1(1), 4(1),
4(2), 6(1), 7(1)
A woman complained about the care
provided by an obstetrician and gynaecologist (the obstetrician) at
Southland Hospital. The woman attempted a normal vaginal delivery,
but it did not progress as expected and assistance was sought from
the obstetric registrar. The registrar made two unsuccessful
attempts to perform a ventouse-assisted delivery then called for
the assistance of the on-call obstetric consultant.
Witnesses to the events reported
that the obstetrician treated the woman in a disrespectful manner
and did not fully explain the delivery options available to her. He
initially advised the registrar to make preparations for a
Caesarean section but then decided to attempt another
ventouse-assisted delivery.
The obstetrician delivered the
baby's head in one contraction, and passed responsibility for the
rest of the delivery to the midwife. The umbilical cord was around
the baby's neck and the midwife attempted to lift it over her head
without success. According to the midwife, the obstetrician then
intervened and attempted to manually lift it over the baby's head,
causing avulsion (tearing) of the cord at the point where it joined
the baby. In contrast, the obstetrician reported that the force of
the woman's next push caused the avulsion of the cord.
After the baby was delivered, the
bleeding from her torn umbilicus was controlled, and she was
transferred to the neonatal unit. The obstetrician delegated the
repair of the woman's vaginal lacerations (tears) to the midwife,
but they were beyond her scope of practice to repair. The
obstetrician subsequently repaired the lacerations under general
anaesthetic.
The baby received paediatric care in
the neonatal unit but her condition deteriorated. Clinicians
suspected a subgaleal haemorrhage and she was transferred to a
larger hospital by helicopter. Despite intensive care the baby died
shortly afterwards.
It was held that the obstetrician
failed to provide obstetric care of an appropriate standard; failed
to provide adequate information about the available delivery
options; failed to obtain the woman's informed consent to the third
attempt at ventouse-assisted delivery; pressured other providers to
make false entries in the clinical notes; made his own misleading
entries in the clinical notes; and failed to discuss the adverse
event with the woman. These failings amounted to breaches of Rights
1(1), 4(1), 4(2), 6(1), and 7(1). The matter was referred to the
Director of Proceedings.
It was also held that Southland DHB
took appropriate care in the recruitment and supervision of the
obstetrician, and therefore was not liable for his actions, and did
not breach the Code.
The obstetrician was referred to the
Director of Proceedings. The Director decided to lay a charge
before the Health Practitioners Disciplinary Tribunal. The Tribunal
concluded that none of the particulars were established, and the
charge was dismissed.
Link to HPDT decision: http://www.hpdt.org.nz/portals/0/med08107ddecdp070web.pdf