Warren, Michigan is the largest suburb of Detroit, and the headquarters for the award winning St. John Providence Health System are located in this city. St. John’s is a regional referral center for high risk pregnancies, and close to 4,000 babies are born here every year. It is critical for physicians to recognize high risk pregnancies because they require much closer monitoring as well as astute management. Failure to properly monitor and manage a high risk pregnancy can cause the baby to suffer birth injuries and develop conditions such as cerebral palsy, hypoxic ischemic encephalopathy (HIE) and intellectual and developmental delays.
WHAT IS A HIGH RISK PREGNANCY?
A high risk pregnancy is one in which the mother or baby has an increased chance of having a health problem. Certain existing health conditions may be the reason a pregnancy is labeled high-risk. The mother’s age and lifestyle factors, as well as certain pregnancy conditions, are also factors that can place a pregnancy at high risk. High-risk pregnancies require closer monitoring and more frequent testing than pregnancies not labeled high risk. In addition, women with these pregnancies are usually referred to maternal-fetal specialists, which are physicians that specialize in high risk pregnancies.
Conditions that can cause a pregnancy to be high risk include the following:
High blood pressure and preeclampsia. Many women with high blood pressure (hypertension) have healthy pregnancies. However, hypertension can cause serious health problems, such as a decreased flow of oxygen-rich blood to the baby. Uncontrolled high blood pressure can lead to kidney damage in the mother, which can cause the baby to have a low birth weight, or the mother to have preeclampsia.
Preeclampsia is characterized by hypertension and proteinuria, or the spilling of protein in the urine. In severe cases, mothers with preeclampsia may have low blood platelet counts, known as thrombocytopenia. Mothers who suffer from hypertension, diabetes, obesity, and those who are greater than 35 years of age are at increased risk for preeclampsia.
Preeclampsia is classified as being mild, moderate or severe. In many cases, however, a mother with even mild preeclampsia can rapidly progress to a more severe form of the disease. Moderate and severe cases of preeclampsia can adversely affect numerous maternal organ systems, including the kidney, liver and blood vessels. Undiagnosed or untreated preeclampsia can also lead to eclampsia, a potentially deadly consequence associated with permanent brain (neurologic) injuries, including intracerebral hemorrhage (brain bleeds), blindness, and death of the mother and baby.
In cases where preeclampsia is undiagnosed or untreated, there may be a decrease in blood flow from the mother’s placenta to the baby, thereby reducing the transfer of oxygen and nutrients to the developing baby. Thus, in cases of moderate to severe preeclampsia, there can be reductions in the amniotic fluid (oligohydramnios), intrauterine growth restriction (IUGR) in which the baby does not grow normally, or placental abruption.
In addition to carefully monitoring and treating the mother with preeclampsia, physicians must also initiate a regimen of fetal surveillance to determine what effects the preeclampsia may be having on the baby. Such tests typically include weekly nonstress tests, biophysical profiles and ultrasound examinations to assess the level of amniotic fluid and to determine whether the baby is growing normally. Because of the extreme risks associated with even mild to moderate preeclampsia, many physicians deliver the babies prior to term.
Diabetes. It is important for women with diabetes to properly manage their blood sugar levels before getting pregnant. High blood sugar levels can cause permanent injury to the baby during the first few weeks of the pregnancy, often before women know they are pregnant.
Gestational diabetes is a condition in which diabetes if first diagnosed during pregnancy. It affects almost 20% of all pregnancies, and the condition typically begins midway through the pregnancy. Gestational diabetes is when the body cannot make and use as much insulin as it needs. Insulin is important because it converts glucose (blood sugar) into energy. Mothers with gestational diabetes have inappropriately high blood sugar levels. If not properly managed, this can cause the baby to become very large, or macrosomic. Macrosomia is dangerous for the baby because it increases the risk of the baby having a birth injury caused by a difficult delivery. This can lead to shoulder dystocia and a brachial plexus injury / Erb’s palsy, oxygen deprivation and HIE, and other permanent conditions such a cerebral palsy.
Obesity. Obesity during pregnancy is associated with a number of problems. It increases a mother’s risk of developing diabetes, as well as having a macrosomic baby, premature delivery, hypertension, prolonged labor, and a C-section delivery. In fact, last year a study was published that found that obesity increases a woman’s risk of vacuum extraction as well as C-section delivery. Not only are women who are obese prior to pregnancy at risk, but women who gain 35 pounds or more during pregnancy are at an increased risk of having a forceps, vacuum extraction and C-section delivery.
Given the impact of obesity on pregnancy, it is very important for physicians to properly advise expecting mothers as well as women who are considering getting pregnant.
Multiple Gestation. Being pregnant with twins, triplets or more increases the risk of giving birth prematurely. Having a baby after age 30 and taking fertility drugs have both been associated with multiple births. Being pregnant with 3 or more babies increases the chance that the babies will have to be delivered by C-section. Twins and triplets are more likely to be small for their size, and babies born prematurely are more likely to have breathing problems after birth, which can lead to overventilation injuries as well as oxygenation problems and HIE.
First time pregnancy. Women older than age 35 are at an increased risk of having the following:
- C-section delivery
- Delivery complications, such as excessive bleeding during labor, which can cause oxygen deprivation and HIE in the baby
- Prolonged or arrested labor
- A baby with a genetic disorder such as Down syndrome
Other health conditions and lifestyle choices. Existing health conditions such as polycystic ovary syndrome, kidney disease, autoimmune disease, thyroid disease and HIV / AIDS also cause a pregnancy to be high risk.
Alcohol consumption and cigarette smoking are very dangerous for the developing baby. Alcohol passes directly through the umbilical cord to the baby. Mothers who consume alcohol during pregnancy are at a high risk of having a miscarriage or stillbirth, and the baby is more likely to have birth defects and fetal alcohol syndrome (FASD), which can cause the child to have intellectual disabilities.
Mothers who smoke while pregnant put their babies at risk of having birth defects and long term health problems, as well as experiencing sudden infant death syndrome (SIDS).
Physicians must properly advise expecting mothers on these conditions and lifestyle choices.
HELP FOR CHILDREN WITH BIRTH INJURIES
The nationally recognized attorneys at Reiter & Walsh ABC Law Centers have been helping children with birth injuries in Warren and throughout the nation for over two decades. Jesse Reiter, the firm’s co-founder, has been focusing on birth injury cases his entire 25+ year career. Jesse has won many awards for his advocacy of children, and he is currently recognized as being one of the best medical malpractice lawyers in America by U.S. News and World Report 2014, as well as one of the 10 Best Attorneys in Michigan by Super Lawyers magazine. Reiter & Walsh ABC Law Centers is also recognized as being one of the best law firms in the country by U.S. News and World Report 2014.
Jesse and his team are passionate about helping children obtain all the support, therapy and treatment they need so they have a good quality of life and a secure future. Jesse and his team will carefully review all medical records to determine if negligence occurred. Once the attorneys see medical malpractice, they aggressively fight to obtain compensation for lifelong care and support of the child, which typically includes treatment, medical devices, housing and education.
Birth injury law is a difficult area of law to pursue due to the complex nature of the medical records. The attorneys at Reiter & Walsh ABC Law Centers have decades of experience with birth injury cases, and have won numerous awards. To find out if you have a case, contact our firm to speak with an experienced attorney. Our attorneys give personalized attention to all clients. We have numerous multi-million dollar verdicts and settlements that attest to our success, and no fees are ever paid to our firm until we win your case. Email or call us at 888-419-2229.