Articles Posted in Cerebral Palsy

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At the moment of birth, the most objective method of assessing a newborn’s metabolic condition is by analyzing umbilical cord blood gas. To be specific, arterial cord pH and base deficit can determine perinatal hypoxia and be an insight into causes of fetal distress.

Umbilical cord blood gases are most likely interpreted in situations of high risk pregnancies when there are abnormal fetal heart rate patterns, when there is an intrapartum fever, emergent C-section for a fetal compromised, low Apgar scores (less than 3) or when there are multiple fetal births.

There are three most common causes of neonates hypoxia or asphyxia, which are when the mother is oxygen compromised, when there is preeclampsia, chronic hypertension, hypotension, hypovolemia or cyanotic heart disease. Another type of condition that causes hypoxia or asphyxia is when the oxygen flow from the placenta to the fetus is obstructed or impaired. This could be caused by a placental abruption, a cord prolapse, or repetitive cord blockage.
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The birth injury to a newborn is perhaps the most heartbreaking injuries that human beings face. The birth of a newborn child is a remarkable event by itself. It comes with the promise of a long and healthy life. However, when an obstetrician, nurse midwife or labor and delivery nurse are negligent, this can cause a birth injury, brain damage or birth trauma. The results are devastating to the baby as well as to the parents and siblings.

In particular, the birth injury to a newborn child who has been injured permanently by the negligence of a labor and delivery team has long-term effects on the mother. In fact, too often mothers are injured during child birth; this may well play a role in their ability to bear more children.

The physical effects on a mother who gives birth to a newborn child coupled with a traumatic labor and delivery injury are easily recognized. The mother may suffer from uterine bleeding, bone fractures and bruising, a uterine rupture that may have been caused by an error in the Cesarean delivery, fissures, infection, pre-eclampsia or eclampsia, uterine hyper-stimulation, vaginal tears or even the wrongful death of the mother. Maternal deaths are much more common than one would expect.
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According to the World Health Organization (WHO), the United States maternal mortality ratio has increased between 1990 and 2013 by 136%. Between 2003 and 2013, there were 7,210 maternal deaths in the U.S., according to the Center for Disease Control’s (CDC) database. The rise in maternal deaths is stunning compared to the rest of the world where the maternal mortality rates have decreased by 45% between 1990 and 2013. Compared to other developed regions of the world, the U.S. is lagging far behind in this area. In developed regions of the world, the maternal mortality ratio was down 38%.

Furthermore, neonatal deaths between 2003 and 2013 numbered 277,886 in the U.S. That number of neonatal deaths compared to Sweden, Iceland and the United Kingdom was significantly higher. The birth trauma injuries for neonates for the year 2004, for example, were 1.1-7.5/1,000 births.

Also alarming is the fact that in the U.S., the likelihood of maternal death in high-poverty areas of the country are twice as high as other areas. The maternal mortality rates per 100,000 live births by race or ethnicity was highest among non-Hispanic black women. The next highest, which was less than half, were of American Indians/Alaska native Americans. In short, African-American women are three times more likely to die from pregnancy-related causes than white women.

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This was a birth injury case in which the jurors were asked to award up to $7.5 million for a life care plan for the baby girl, Jill Todd, as well as $1.4 million in lost wages and an unspecified amount of damages for pain and suffering. The issue in this case was whether the University of Iowa’s Health Center physicians and staff provided proper care to Jill Todd in November 2010.  After two days of deliberation, the jury returned a 9-1 verdict finding that the University of Iowa Health Center was negligent but that negligence wasn’t “a cause of damage” to the child. This was an odd verdict or at least one that most would consider inconsistent.

Investigators confirmed that they were looking into an unusual claim of jury tampering in this medical malpractice, birth injury case involving the University of Iowa Hospitals and Clinics. As a result of the jury’s unusual verdict, the University of Iowa Hospitals and Clinics paid nothing for the injured child.

After a 3-week trial, the jury found that the hospital was negligent in caring for a mother who suffered complications before giving birth in 2010. But the jurors found that negligence was not a cause of damage to the child. The baby suffered brain damage and is severely disabled. The jury awarded no compensation to the family.

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In a recent report it was stated that cerebral palsy affects nearly 10,000 newborns every year. The statistics are more troubling in that research shows that 25-35% of all cerebral palsy cases could have been prevented. It has been reported that medical errors during or after the delivery of a child was the cause of cerebral palsy in 35-45% of deliveries.

The diagnosis of cerebral palsy occurs usually by 18 months of age. One in 323 children has been identified with cerebral palsy. The malady is more common in boys than in girls. In addition, cerebral palsy is found more often in children of African-American descent than in Caucasian, Asian or Hispanic children.

The medical costs of caring for and treating a child with cerebral palsy are enormous. According to the study, the lifetime cost of care for an individual with cerebral palsy is almost $1 million.

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When an infant is tragically injured during childbirth by the negligence of an obstetrician, nurse wife or nurse, the defense, with few exceptions, relies on medical publications. Most of these publications come from the American College of Obstetricians and Gynecologists (ACOG). On the other hand, a plaintiff’s neuroradiology expert would be called to testify about the baby’s time of injury. ACOG has taken most birth trauma injury cases as having occurred in the prenatal stages of childbirth. In other words, during labor and delivery the HIE injury (hypoxic ischemic encephalopathy), which is the basis for the lawsuit, didn’t occur during labor and delivery, but instead occurred as a matter of course during the time prenatally. That’s the standard defense.

ACOG published in January 2003 a document that created strict criteria for establishing the existence of intrapartum HIE. Applying this stringent criteria, ACOG defenders argued that the injury to the baby occurred not during labor and delivery but prenatally. The claim that the baby was asphyxiated intrapartum, that is during labor and delivery, could not have happened because the strict criteria were not met.

The published paper by ACOG took the position that 4-10% of moderate to severe neonatal encephalopathy occurred as a result of hypoxia in the intrapartum period.

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On Sept. 5, 2015, Jaclyn Pena-Prather arrived at Sherman Hospital in Elgin, Ill., for an elective induction of labor. She was more than 41 weeks’ pregnant. She was a patient of Dr. Carol Korzen, who practiced obstetrics and gynecology in Elgin.

After admission, an external monitor was applied, and the fetus was continuously monitored throughout labor. At 2:15 a.m. on Sept. 6, 2015, she received an epidural for pain. At 4:45 a.m., a nurse contacted Dr. Korzen to update her on the patient’s progress. Dr. Korzen was present at 7:20 a.m. Pena-Prather was coached to begin pushing. At 8:21 a.m., the baby, Gianna, was delivered vaginally, weighing 6 lbs., 4 oz.

However, Gianna’s Apgar scores were very low. One minute after birth, Gianna’s score was zero. At 5 minutes, her score was 1. At ten minutes, her score was 3. The umbilical cord was described as “thin and shoe-string-like,” and was coiled seven times. Gianna was diagnosed with hypoxic-ischemic encephalopathy (HIE) and metabolic acidosis.

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H.D. was admitted to a hospital in labor. The nurses and midwife observed H.D. throughout the night without any notable changes. However, early the next morning, the fetal monitor showed non-reassuring signs of the unborn child. No one consulted an obstetrician or warned a doctor about the non-reassuring signs.

About six hours later, H.D. delivered her son; he was born with the umbilical cord wrapped around his neck three times. The hospital’s resuscitation team was attending to another patient, which resulted in an 8-minute delay in having the child intubated.

As a consequence, the baby suffered severe brain damage. He is now 6 years old and has cerebral palsy, developmental delays and a seizure disorder.

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In 2008 a study was published that focused on uncomplicated pregnancies. The question was whether to induce labor in women whose gestation had reached 41 to 42 weeks. It was revealed that inducing labor in women who have reached 41 weeks of pregnancy and who were otherwise low-risk showed the condition of the baby at birth to be favorable. The goal of obstetricians was to ensure the successful delivery of the baby before 42 weeks of gestation — for the benefit of the baby and mother.

The study suggested that there was an improvement in prenatal outcomes as a result of a more proactive post-term (more than 39 weeks) labor induction practice.

This guideline has shown that there was a significant reduction in the number of stillborn infants at term, 39 weeks of gestation. In addition to this conclusion, it was found or suggested that maternal deaths were also improved with proactive labor induction.

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The baby, Zoey Stavrou, was delivered by Cesarean section at Edward Hospital in DuPage County, Ill., at 12:25 a.m. on May 14, 2006. She had Apgar scores at 0 at 1, 5 and 10 minutes. At the time of the delivery, a 9-centimeter umbilical cord hematoma was discovered, which had occurred as a result of a ruptured umbilical vein.

Zoey is now 8 years old and has severe cerebral palsy. She is non-verbal and has no functional mobility. She has the cognitive level of a 6-9 month infant and is dependent for all activities of daily living.

Zoey’s family contended that the defendant delivering physician and labor and delivery nurses chose not to properly interpret and act upon non-reassuring fetal monitor strips throughout the evening of May 13. They also contended that the emergency C-section should have been ordered around 9 p.m., but the defendant obstetrician, Dr. Chen, negligently waited until midnight to order the C-section. It was also claimed that Dr. Chen did not perform the incision for the C-section until 12:19 a.m. and the child would have been born neurologically intact if she had been delivered before 12:08 a.m.

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