What Causes Hypoxic-Ischemic Encephalopathy (HIE)?

Hypoxic-ischemic encephalopathy (HIE) is a neonatal brain injury. A lack of oxygen or blood flow to the baby’s brain causes HIE. While the baby is in the womb, they get oxygen from the flow of nutrient-rich blood. HIE is a type of birth injury that occurs when a baby does not get enough oxygen before birth. It is also called birth asphyxia.

A variety of factors may lead to HIE, including:

maternal health issues
labor and delivery complications
infections
improper fetal monitoring
failure to provide needed intervention and delivery in time (such as an emergency C-section)

In most cases, neonatal hypoxic- ischemic encephalopathy is preventable. A timely delivery can prevent most of the medical conditions and complications that can cause HIE.

How can a lawyer help my child with hypoxic-ischemic encephalopathy?

Unfortunately, many cases of HIE are the result of negligent actions by medical professionals and hospitals. When negligence causes HIE and/or other forms of harm to a patient, it is considered medical malpractice. A lawyer experienced in HIE cases can review your records and find out whether medical malpractice caused your child’s HIE.

It can be devastating to learn that negligence caused your child’s HIE. A child with HIE can have extensive care needs from disabilities related to HIE (such as cerebral palsy). As a parent, you have the option of pursuing a birth injury lawsuit to obtain justice for your child. Legal action can cover the cost of your child’s long-term medical care and other expenses.

Most common causes and risk factors for HIE

Delayed Emergency C-Section

A delayed emergency C-section forces the baby to remain in oxygen-depriving conditions. This lack of oxygen can cause HIE.

Many of the causes of HIE warrant an early, planned delivery. In other cases, urgent situations may require delivery via emergency C-section. Medical staff must perform a C-section quickly. The emergency C-section delivery must occur in time to prevent brain injury, which can occur after the baby does not get enough oxygen.

Hospitals with labor and delivery services should have the required equipment and staffing for emergency C-sections.

Research about emergency c-sections shows that medical staff should deliver the baby within five to 30 minutes to prevent brain injury. A short decision-to-delivery interval is important for emergencies. Delays can lead to poor outcomes for both the mom and the baby.

Risk factors and causes of HIE

Maternal Health Issues

Doctors should provide safe and careful medical care to all expectant mothers. A patient with a high-risk pregnancy may need special precautions. A high-risk pregnancy can also increase the risk of HIE.

Diabetes or gestational diabetes

Both pre-existing diabetes and gestational diabetes can increase the baby’s risk of HIE and other birth injuries. Gestational diabetes is when a woman receives a diagnosis of diabetes (high blood sugar) for the first time part-way through pregnancy.

Medical professionals can safely manage a patient’s diabetes throughout pregnancy. They can provide dietary counseling, exercise, insulin, and other interventions.

Diabetes can cause the fetus to become too large or too small for gestational age. Both situations increase the risk of delivery complications and HIE.

High blood pressure or preeclampsia

Maternal high blood pressure and preeclampsia both make a pregnancy high-risk. Preeclampsia is a condition where the mother develops high blood pressure and other signs of organ dysfunction during pregnancy. Signs of preeclampsia can develop around 20 weeks.

These conditions increase the risk of placental abruption and other complications in pregnancy and during labor and delivery. A placental abruption is an emergency where the placenta detaches from the uterine wall before the baby’s birth. Placental abruption can lead to dangerous maternal bleeding and oxygen deprivation in the baby, leading to HIE. Delivery must be performed in time to prevent brain injury.

Maternal obesity

Obesity during pregnancy increases the risk of complications. Research shows that children born to obese mothers are more likely to have cerebral palsy due to oxygen deprivation when not delivered in time. Obesity increases the risk of preterm birth and other conditions that can lead to birth asphyxia or HIE.

Multiples pregnancy

Women pregnant with twins and other multiples are at increased risk of complications that can lead to HIE. These include premature birth, umbilical cord problems, preeclampsia, placental abruption, uterine rupture and gestational diabetes. According to ACOG, a patient with a multiples pregnancy should have more frequent prenatal visits to monitor for issues.

Maternal age

“Advanced maternal age” (AMA) usually refers to women over the age of 35. More detailed research shows the risks associated with age increase more on a continuum basis. Additional studies suggest older mothers are at a higher risk of developing conditions like preeclampsia and gestational diabetes. These and other conditions related to AMA can increase the likelihood of HIE.

Umbilical Cord Issues

The umbilical cord connects a mother to her unborn baby. The umbilical cord is the baby’s lifeline and source of oxygen and nutrients. Complications involving the umbilical cord greatly increase the risk of HIE.

Proper prenatal testing and fetal monitoring can detect these issues and allow for delivery in time before HIE occurs. Without timely diagnosis and management, the consequences can be catastrophic. Umbilical cord issues include:

Umbilical cord compression: When the umbilical cord is squeezed or constricted, it puts the baby at risk of not getting enough oxygen. Several of the following conditions can cause cord compression.
Nuchal cord: The umbilical cord loops around the baby’s neck.
True knot: The umbilical cord tangles and ties in a knot.
Umbilical cord prolapse: The cord descends the birth canal before or alongside the baby.
Short umbilical cords: A short cord can stretch and rupture. These circumstances may lead to placental abruption.
Vasa previa: Vasa previa is a complication with the blood vessels of the umbilical cord. The umbilical cord vessels migrate out into the amniotic sac membranes and may rupture during delivery. Vasa previa can lead to massive fetal blood loss and brain injury to the baby. A planned C-section must be performed to prevent brain injury due to blood loss from vasa previa.

Placental Issues

Placental complications can dangerously deprive a baby of oxygen and cause HIE.

Placental abruption: The placenta separates prematurely from the uterine lining.
Placenta previa: This is a condition in which the placenta lies too low in the uterus. The placenta partially or completely covers the mother’s cervix and may block the baby’s passage out of the womb.
Placenta accreta: The placenta does not properly separate from the uterus during labor and delivery. This can happen if the placenta has grown too deeply into the uterine wall. Placenta accreta can cause severe hemorrhages, which can pose a serious health threat to both mother and child. If medical staff detect placenta accreta early, they can treat the condition.
Placental insufficiency: If a pregnancy involves placental insufficiency, the placenta is unable to supply enough oxygenated, nutrient-rich blood to the baby. Treatment may involve addressing underlying causes such as high blood pressure and diabetes. In most cases, early delivery will also be necessary.

Postterm Pregnancy

Postterm pregnancy is a name for pregnancies that last longer than nine months, the standard gestation time. Postterm pregnancy complications can lead to HIE.

Chorioamnionitis and Villitis

Chorioamnionitis is infection and inflammation of the placenta and fetal membranes. Villitis is when the infection spreads to the part of the placenta that gives the baby oxygen and nutrients. These infections can cause HIE or another birth injury where the baby is not delivered in time.

Meconium Aspiration

Meconium is a mixture of amniotic fluid and the baby’s stool. Sometimes, babies breathe meconium into their lungs around the time of birth. This is meconium aspiration syndrome (MAS).

When this happens, the baby can suffer severe respiratory distress. The baby’s respiratory distress can cause or contribute to oxygen deprivation and HIE. Oxygen deprivation and fetal distress can also cause MAS.

Did your child suffer HIE? Our team can answer any questions you may have about a potential case.

Fetus Cannot Fit Through Birth Canal

In some cases, a baby is unable to fit safely through the mother’s birth canal. This can cause prolonged and arrested labor, traumatic birth injuries, and oxygen deprivation or HIE. Issues with the baby’s size may stem from a variety of complications

Macrosomia

The baby is unusually large for gestational age.

Cephalopelvic disproportion (CPD)

CPD describes a situation in which the baby’s head is too large to fit through the mother’s pelvis or the mother’s pelvis too small to fit the baby. CPD can occur if the baby’s head is too large or the mother’s pelvis is too small.

Abnormal fetal presentation/lie

Normally, the baby settles into a head-first position before birth. If the baby does not present this way, complications can occur. The different positions include:

Sometimes, medical professionals attempt to pull the baby out using forceps or vacuum extractors. When used improperly, these tools can cause trauma to the baby’s head, brain hemorrhages, and HIE. In many cases, medical professionals should perform a C-section instead.

Uterine Rupture

Uterine rupture occurs when the uterus (womb) tears open. When the uterus tears, the mother may lose so much blood that the baby becomes oxygen-deprived. The rupture can cut off blood flow to the placenta and umbilical cord. A tear can expel the baby out of the womb and into the mother’s abdomen.

Women who have a vaginal birth after C-section (VBAC) or trial of labor after cesarean (TOLAC) are at an increased risk of uterine rupture. Prior history of C-section or surgery to the uterus also increases the risk. Most women with history of C-section have a C-section in their subsequent pregnancies to avoid uterine rupture.

Several Maternal Hypotension

Maternal hypotension is when the mother’s blood pressure is low. This complication can occur as a side effect of spinal anesthesia or other complications. Low blood pressure can cause the baby to not receive enough oxygenated blood through the placenta and umbilical cord. The lack of oxygen can cause HIE. Material hypotension must be diagnosed and treated in time to ensure the baby gets enough oxygen.

Intracranial Hemorrhages

Intracranial hemorrhages (brain bleeds) can occur when there is trauma to the baby’s head or from HIE. Forceps and vacuum extractors may cause injuries to the baby’s head during labor and delivery as well as traumatic labor and delivery. If medical staff mismanages the baby’s birth position, the baby can also have head trauma. Brain bleeds can cause decreased blood flow and oxygen in the brain and result in brain injury.

Uterine Hyperstimulation (Tachysystole)

Uterine hyperstimulation (tachysystole) refers to a complication in which uterine contractions become excessively strong, long or too frequent. This can result from improper use of the labor-enhancing drugs Pitocin and Cytotec.

Uterine hyperstimulation puts too much pressure on the vessels in the uterus and placenta. These contractions can impede blood flow to the umbilical cord and baby. This can lead to severe oxygen deprivation and HIE.

Birth injury attorneys helping children with HIE

The attorneys at ABC Law Centers (Reiter & Walsh, P.C.) advocate for babies with HIE and other birth injuries. Our firm has exclusively focused on birth injury since 1997. Our niche practice allows us to provide unparalleled service to our clients.

A birth injury or HIE diagnosis can be tough on your whole family. Our firm has worked with families like yours for over 25 years. We have been honored to advocate for their children and secure the costs of their lifetime care. Let us help you get the same peace of mind, knowing your child will be cared for, no matter what.

Call our HIE attorneys today with any questions you may have. Our team is ready to provide answers and information about your legal options. We are available 24/7 to speak with you.

“Jesse, Rebecca and team are fabulous lawyers. So knowledgeable and compassionate; I highly recommend them.”

-Client review from 4/18/2016

Tell us your story.

Dealing with a birth injury diagnosis can be difficult, but our attorneys can help. The ABC Law Centers: Birth Injury Lawyers team focuses exclusively on birth injury and are dedicated to earning justice for families like yours.

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Related resources

- HIE Help Center

Video: Michigan hypoxic-ischemic encephalopathy (HIE) lawyers discuss birth asphyxia and HIE

Watch a video of partners Jesse Reiter and Rebecca Walsh talking about the causes of HIE and the groundbreaking treatment for this condition.

What causes hypoxic-ischemic encephalopathy (HIE)?