HIE and Umbilical Cord Problems
Hypoxic Ischemic Encephalopathy, Nuchal Cord, Umbilical Cord Prolapse, Short Cord, True Knot & Vasa Previa Lawyers
Neonatal encephalopathy (NE) is a term used to describe disturbed brain function in a baby. Neonatal encephalopathy indicates that there is evidence of brain swelling caused by an insult to the baby’s brain. Hypoxic ischemic encephalopathy (HIE) is the most common type of NE, and it is caused by oxygen deprivation (hypoxia) in the baby and reduced blood flow (ischemia) in the brain. Babies with neonatal encephalopathy and HIE usually have seizures and exhibit a low level of consciousness. Throughout this page, our Michigan HIE attorneys will discuss the relationship between HIE and umbilical cord problems.
Reduced oxygen flow to the baby (birth asphyxia) is the most common cause of neonatal encephalopathy and hypoxic ischemic encephalopathy in a newborn. Umbilical cord problems are a common cause of birth asphyxia because the umbilical cord is the lifeline that carries oxygen-rich blood to the baby, which is the baby’s only source of oxygen. Prolonged labor, a delayed C-section and problems with the uterus and placenta are also common causes of birth asphyxia, neonatal encephalopathy and hypoxic ischemic encephalopathy. Maternal infection passed to the baby at birth, sepsis and meningitis can also cause neonatal encephalopthy.
If infection, sepsis and meningitis are quickly treated and if hypothermia treatment is promptly given to a baby who has HIE, the baby may have no permanent brain damage. Sadly, however, many babies who experience encephalopathy are left with permanent brain damage and conditions such as cerebral palsy, seizure disorders, hydrocephalus, intellectual disabilities and developmental delays. In premature babies, the brain injury may take the form of periventricular leukomalacia (PVL), which can also cause the aforementioned conditions. Hypoxic ischemic encephalopathy usually involves damage to the basal ganglia, watershed regions of the brain and cerebral cortex, but it sometimes does include PVL.
Neonatal Encephalopathy, Hypoxic Ischemic Encephalopathy / HIE and Umbilical Cord Problems
An unborn baby receives oxygen-rich blood from the mother that diffuses through blood vessels in the placenta and is then carried to the baby via the umbilical cord. Complications that cause the umbilical cord to rupture or become compressed can cause the baby to be oxygen deprived. This is an emergent situation, but the medical team will be able to recognize oxygen deprivation and birth asphyxia through heart tracings provided by the fetal heart rate monitor. Oxygen deprivation manifests on the heart monitor as nonreassuring heart tracings. As soon as these tracings occur, the baby should be quickly delivered, usually by emergency C-section. While preparations are being made for prompt delivery, certain maneuvers can be performed (in some situations) in an attempt to decrease cord compression and birth asphyxia.
Umbilical cord problems include:
- Nuchal cord (cord wrapped around baby’s neck)
- Umbilical cord prolapse
- Short umbilical cord
- Cord in a true knot
- Vasa previa.
Nuchal Cord, Birth Asphyxia, and HIE (Hypoxic Ischemic Encephalopathy)
A nuchal cord is when the umbilical cord is wrapped around the baby’s neck. In some cases this will be a nuchal loop that can be undone when the baby moves. In others, the nuchal cord may become knotted. Nuchal cords can cause birth asphyxia in a number of ways. They can cause cord compression, compression of the blood vessels in the baby’s neck, and back up of venous blood, which greatly hinders circulation.
The most common sign of a nuchal cord is decreased fetal activity after week 37. If a knot occurs during labor, the fetal monitor will likely detect a nonreassuring heart rate.
Video: Nuchal Cord
True Knot, Birth Asphyxia, and HIE (Hypoxic Ischemic Encephalopathy)
When the umbilical cord is in a true knot, severe cord compression can occur. Knots are associated with monoamniotic twins, polyhydramnios (too much amniotic fluid), early pregnancy, having had 2 or more pregnancies (multiparity) and long umbilical cords.
Decreased fetal activity after week 37 is a common sign of a true knot. A nonreassuring heart rate will occur when the knot is serious enough to cause a lack of oxygen to the baby’s brain.
Video: Umbilical Cord Knots
Cord Presentation, Umbilical Cord Prolapse, and HIE (Hypoxic Ischemic Encephalopathy)
Cord presentation occurs when the mother’s membranes are intact and the umbilical cord is the first presenting part. A cord presentation poses no risk when the membranes are intact but can very quickly become an emergency when the mother’s water breaks. When the mother’s water breaks, the amniotic fluid rushes from the uterus and can take the cord with it. This means that a cord presentation can very quickly become a cord prolapse, which is a medical emergency. Cord prolapses can cause a baby to be deprived of oxygen during labor and delivery when the cord becomes compressed against the baby’s head, the mother’s pelvis, or by overly-strong contractions. Because the risk of cord prolapse is so high, medical professionals should be watching for cord presentation after 32 weeks and take measures (such as recommending a planned C-section birth) to prevent the risk of cord prolapse and oxygen-deprivation related injuries such as HIE, cerebral palsy, and intellectual or developmental disabilities
Umbilical Cord Prolapse, Cord Compression, and HIE (Hypoxic Ischemic Encephalopathy)
A prolapsed umbilical cord refers to the cord dropping in front of the baby in the birth canal during delivery. The cord is then at high risk of being compressed between the baby’s body and the mother’s pelvis. This can also cause complete cord compression.
There are two types of umbilical cord prolapse:
- Overt prolapse. This happens when the cord comes out of the cervix or vagina before the presenting part of the baby and is either visible or able to be felt by the medical practitioner.
- Occult prolapse. This occurs when the cord descends alongside but not past the presenting part of the baby. It can happen with ruptured or intact membranes.
The most obvious sign of a prolapsed umbilical cord is seeing or feeling the cord before the baby is delivered. A nonreassuring heart tracing from a lack of oxygen will also usually be seen.
Video: Occult Cord
Short Umbilical Cord, Cord Rupture, Placental Abruption, and HIE (Hypoxic Ischemic Encephalopathy)
When the baby has a short umbilical cord, it is at risk of stretching and rupturing. The cord also may pull on the placenta, causing the placenta to tear away from the wall of the uterus (placental abruption). Indeed, vessel rupture and placental abruption are major risks of having a short umbilical cord, and these conditions can cause severe bleeding, hemorrhaging and birth asphyxia.
The umbilical cord can be visualized with ultrasound by about the 8th week. Second and third trimester ultrasound exams to determine the number of vessels in the cord is the standard of care, although many experts prefer a more detailed exam of the cord at this time. A detailed evaluation includes assessment of wharton’s jelly (a mucous tissue that protects the umbilical vessels), evaluation of the fetal and placental insertion sites (including location of the cord on the placenta) and determination of the helical pattern (twisting of the cord). Length of the cord should be noted, and very close monitoring of the mother and baby must take place if the cord is short or other cord abnormalities are present.
Vasa Previa, Cord Rupture, and Hypoxic Ischemic Encephalopathy (HIE)
Vasa previa is a condition in which the baby’s blood vessels are exposed and covering the opening to the birth canal. Normally, the baby’s blood vessels are inside the umbilical cord, which inserts into the central area of the placenta. In vasa previa, some of the baby’s blood vessels travel within the fetal membranes and across the opening of the birth canal. The blood vessels insert into the surface of the placenta and are exposed because they are unprotected by placental tissue or the umbilical cord.
Blood vessels affected by vasa previa are at risk of rupturing when the fetal membranes rupture or during labor and delivery. A vessel rupture can cause the baby to lose a lot of blood – even 50% or more of the baby’s total blood volume – which is why vasa previa is such a dangerous condition and must be recognized prior to delivery. If a rupture occurs, members of the medical team must immediately order blood products so the baby can get a transfusion right after birth. With all umbilical cord problems, recognition before an emergency situation occurs is ideal and the baby must often be delivered early. When vasa previa is present, the baby’s health depends on a timely diagnosis. Due to the risk of sudden and severe bleeding if the vessels rupture, a C-section delivery should be scheduled.
Diagnosis of vasa previa is based upon ultrasound findings (membranous vessels that cross the opening of the birth canal). In the absence of a prenatal ultrasound diagnosis, a clinical diagnosis of vasa previa can be made when there is vaginal bleeding that occurs upon rupture of the membranes and is accompanied by a nonreassuring heart tracing.
Abnormal Umbilical Cord Structure, Intrauterine Growth Restriction and Hypoxic-Ischemic Encephalopathy (HIE)
How Many Umbilical Cords Does a Baby Have?
Under normal circumstances, babies have a single umbilical cord with two arteries and one vein. In some cases, however, the baby has only one artery and one vein (a condition called a’ 2-vessel cord’ or ‘single umbilical artery’ (SUA)). Doctors identify abnormal umbilical cord structure during routine prenatal ultrasound tests. A two-vessel cord can sometimes predispose the baby towards growth issues during pregnancy or other abnormalities, so it should be carefully monitored by medical professionals. Mothers with umbilical cord abnormalities are often referred to a maternal-fetal medicine specialist (MFM) who focuses specifically on high-risk pregnancies.
Diagnosing HIE and Umbilical Cord Problems: The Importance of Preventing HIE with Cord Complication Detection
As discussed, problems with a baby’s umbilical cord can be diagnosed with an ultrasound. It is the standard of care to perform ultrasound studies of the umbilical cord during the second trimester or sooner if the mother has certain risk factors. During prenatal testing, fetal distress caused by umbilical cord problems will show up on the fetal monitor as nonreassuring heart tracings. In addition, if there is a long-term (chronic) umbilical cord problem that is causing oxygen and nutrient deprivation, prenatal tests may show decreased fetal movement and intrauterine (fetal) growth restriction (IUGR / FGR). Dangerous umbilical cord problems and evidence of poor fetal well-being are almost always indications for early delivery.
Treatment for Neonatal Encephalopathy and Hypoxic Ischemic Encephalopathy (HIE)
The treatment for hypoxic ischemic encephalopthy (HIE) is hypothermia (brain cooling) treatment. During treatment, the baby’s core body temperature is cooled to a few degrees below normal for 72 hours. This treatment must be given within 6 hours of the insult (usually birth asphyxia) that caused the HIE, which often means it must be given within 6 hours of birth. Research shows that hypothermia treatment halts almost every injurious process that starts to occur when the brain experiences a hypoxic / ischemic insult. It can prevent a baby with HIE from developing cerebral palsy or it can reduce the severity of CP.
Hypothermia treatment is the only treatment for hypoxic ischemic encephalopathy. However, conditions that a baby has a result of the HIE, such as seizures and breathing problems, must be promptly treated or the baby may develop further brain injury.
If a baby has neonatal encephalopathy, the condition that caused it must be quickly treated when possible. Infection that travels from the mother to the baby at birth, such as group B strep (GBS), should be treated. Mothers must receive appropriate antibiotics during labor because the antibiotics will transfer to the baby and help prevent infection in the baby. After birth, the baby may need antibiotics and other treatments if she were exposed to an infection such as GBS. If infection in a newborn isn’t promptly diagnosed and treated, the baby can develop sepsis and meningitis, which can cause neonatal encephalopathy. When a baby has onset of encephalopathy caused by infection, the longer it takes the medical team to diagnose and treat the infection, the worse the brain damage will likely be. Indeed, medical problems that result from encephalopathy as well as underlying conditions that cause encephalopathy must be promptly treated, when possible.
Legal Help for Umbilical Cord Injuries and HIE
If your child was diagnosed with a birth injury such as cerebral palsy, a seizure disorder or hypoxic ischemic encephalopathy (HIE), the award-winning birth injury lawyers at ABC Law Centers can help. We have helped children throughout the country obtain compensation for lifelong treatment, therapy and a secure future, and we give personal attention to each child and family we represent. Our nationally recognized birth injury firm has 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 Reiter & Walsh ABC Law Centers at 888-419-2229 for a free case evaluation. Our firm’s award winning hypoxic ischemic encephalopathy (HIE) lawyers are available 24 / 7 to speak with you.