A little boy named Charlie had to be delivered by emergency C-section at only 24 weeks of gestational age because his mother had a placental abruption, which is a dangerous condition in which the placenta separates from the uterus (womb). The separation decreased the amount of oxygen-rich blood Charlie was receiving in the womb, and as a result, he suffered a brain injury called hypoxic ischemic encephalopathy (lack of oxygen in the brain) that led to cerebral palsy.
Charlie weighed only 1 pound, 15 ounces, and was so small, his mother could hold him in the palm of her hand. Charlie was eventually diagnosed with spastic quadriplegic cerebral palsy, which is a type of cerebral palsy that affects movement of all 4 limbs, and is characterized by stiff muscles.
Little Charlie missed all his developmental milestones, and didn’t speak until he was 3 years old. Charlie’s mother, Tracy, found a program for Charlie that helped him develop and become very talkative. But Charlie was still unhappy because there were many things he was unable to do; he wanted to walk, play soccer, and be like other kids.
When Tracy learned about a program that could help Charlie walk, she and her husband were torn. The surgery, called selective dorsal rhizotomy (SDR), involves exposing and manipulating the child’s spinal cord. A mistake had the potential to leave Charlie paralyzed. The family took a leap of faith, and Charlie had the surgery at age 6.
The family feels that the SDR turned out perfectly. Charlie’s muscles, which were once stiff as a board, are much more loose. Charlie is doing intense physical therapy for several hours a day. Therapy includes walking, squats, and using muscle stimulating equipment. Although the physical therapy is grueling, Charlie says that his body feels like new. After months of therapy, Charlie is able to walk with a walker and no other assistance. His walking gets better everyday, and his parents are excited about how bright the future is for Charlie.
Tracy said that the level of technology for helping children with disabilities is great today, and it gives her so much hope when she thinks of the long term potential.
At a recent therapy session, Tracy sat next to Charlie as his therapist helped him with the exercise ball. He looked back at her for encouragement, even as he struggled and said he couldn’t keep going. As he rolled closer to her, they extended their hands for a high five.
As their hands touched, Charlie said, “I’m a superhero and you’re Super Mommy!”
When the placenta tears away from the womb, it can be very dangerous. The placenta supplies oxygen rich blood to the baby through the umbilical cord, which is attached to the placenta and baby. When the placenta is torn from the womb, it cannot receive the normal amount of blood from the mother. The tear may be small, in which case the oxygen deprivation may be minor, or the tear may be large or in such a spot that the baby becomes almost completely deprived of oxygen. The severity of oxygen deprivation depends on the location of the tear, how long the tear has been present, the size of the tear, and how much reserve the baby has. Regardless of the type of tear that is present, the baby should be delivered immediately, in most cases. This is because a small tear can become a large and serious tear very quickly. An emergency C-section is usually the fastest and safest method of delivering the baby during a placental abruption.
There are a number of conditions and risk factors associated with placental abruption. They include:
- Maternal hypertension (preeclampsia / high blood pressure). This is the most common cause of placental abruption occurring in about 44% of cases.
- Previous C-section delivery
- Sudden decompression of the uterus from events such as the delivery of the first child in a multiples birth or premature rupture of membranes (mother’s water breaking too soon)
- Accidental puncture of the placenta from a needle during amniocentesis
- Chorioamnionitis (an infection of the two membranes of the placenta and the amniotic fluid.)
- Abnormal uterine blood vessels
- Previous placental abruption
- Mother over the age of 35 or younger than 20
Signs and symptoms of placental abruption can include:
- Internal bleeding (occurs roughly 30-40% of the time)
- Low blood pressure
- Placental abruption progression
- Bleeding during the second half of pregnancy or excessive bleeding during labor
- Intense abdominal pain
- Uterine contractions during labor that last longer than normal
- Uterus that becomes hard to the touch during labor
- Fetal distress
- Uterine irritability
Physicians should be aware of all risk factors a mother may have for placental abruption and should be alert for signs of the condition. As with any delivery, a mother should be closely monitored. Sometimes placental abruption can be seen on an ultrasound. If any signs or symptoms of placental abruption are present, the medical team should be prepared for a quick delivery by emergency C-section. Approximately 12% of placental abruptions cause death in the baby, so it is a condition that requires delivery in a matter of minutes.
Hypoxic Ischemic Encephalopathy and Cerebral Palsy
Hypoxic ischemic encephalopathy (HIE) occurs when there is a lack of oxygen in the brain, which can be due to lack of oxygen in the blood, lack of blood flow in the brain, or both. Oxygen is necessary to sustain brain cells. When the brain does not receive proper oxygenation, cell death occurs. This lack of oxygen and subsequent cell death (brain damage), can result in mental and physical disabilities such as intellectual and developmental disabilities, learning disabilities, cerebral palsy and seizures. The extent and seriousness of the damage depends on how low the baby’s oxygen level became, the length of time that the baby was deprived of oxygen, and the condition of the baby prior to the oxygen deprivation. Placental abruption can severely deprive a baby of oxygen and cause HIE.
Cerebral palsy is a neurological disorder characterized by impaired movement and motor function, and it can be caused by oxygen deprivation and HIE. Symptoms of cerebral palsy include weakness, overly rigid muscles, poor muscle control and muscle spasms.
Spastic quadriplegia cerebral palsy is distinguishable from other forms of cerebral palsy in that children afflicted with the condition have stiff, jerky movements stemming from an abnormally high muscle tone, called hypertonia. Spastic quadriplegia involves both the arms and legs.
SDR Surgery For Spastic Quadriplegia
SDR is a surgical procedure that has been shown to help children with spastic diplegia walk. Research has shown that when SDR is coupled with physical therapy, there is a reduction in spasticity and an improvement in motor function. SDR is a neurosurgical procedure that selectively destroys problematic nerve roots in the spinal cord. During SDR, the lower vertebrae are opened to reveal the spinal cord, which contains neurons of the central nervous system. These neurons (bundles of nerve fibers) relay messages between the brain and different areas of the body. Electrical stimulation is used to identify and sub-divide sensory and motor nerves, cutting and eliminating the over-firing (bad) nerve rootlets and leaving the properly firing (good) rootlets intact. Due to the size of the nerves and rootlets, this is a very precise procedure and surgery can last many hours.
Physical therapy is an important part of a treatment program for children with cerebral palsy, because exercise can improve mobility. Indeed, when children have surgery to improve muscle function and gross motor skills, physical therapy is required to gain maximum benefit form the surgery.
Spastic quadriplegia can require surgery and lifelong therapy, which can be very costly.
Help For Families Whose Children Suffered A Birth Injury and Have Cerebral Palsy
Prenatal care and regular examinations are crucial to ensuring the healthy birth of a baby. If a mother has risk factors for certain conditions, such as placental abruption, her pregnancy should be watched very closely. Labor and delivery require close and continuous monitoring, and if placental abruption occurs, the baby must be delivered within a matter of minutes by emergency C-section. Delaying a C-section when an abruption occurs can cause the baby to be severely deprived of oxygen, which can cause permanent brain damage, such as HIE and cerebral palsy, as well as death.
If you had a placental abruption and your child has a permanent injury, such as cerebral palsy, the nationally recognized attorneys at Reiter & Walsh ABC Law Centers can review the medical records and determine if negligence caused your baby’s injury. Our attorneys exclusively handle birth injury cases, and we can help you obtain the compensation you need for treatment and lifelong therapy for your child. We have numerous multi-million dollar verdicts that attest to our success and you never pay any money until we win your case. Please e-mail or call us toll-free at 888-419-2229.