Medical Malpractice Attorneys Discuss the Importance of a Planned Early Delivery to Prevent Birth Injuries when the Mother a High-Risk Condition
Sometimes a baby must be delivered prior to term because the environment inside the womb is sub-optimal and/or conditions exist that increase the baby’s risk of experiencing a sudden lack of oxygen to her brain, which is called birth asphyxia. Indeed, when standards of care for the timing and management of early delivery are followed, a preterm birth can help prevent birth injuries and brain damage in the baby. An obstetrician must take a thorough history of the mother as soon as pregnancy is confirmed. If her history or a current condition makes the pregnancy high-risk, she should be referred to a maternal-fetal specialist and her prenatal testing should occur more frequently than normal. An obstetrician must look closely for signs of any problems that can be harmful to or risky for the baby. Pregnancy issues that can cause birth injuries include those that cause the fetus to receive less oxygen and nutrients than normal or conditions that place the baby at risk of experiencing a sudden complication that causes birth asphyxia. The following are some common birth injuries that can occur when a baby’s delivery is mismanaged:
- Hypoxic ischemic encephalopathy (HIE). HIE usually involves damage to the basal ganglia and watershed regions of the brain, but sometimes also includes periventricular leukomalacia (PVL)
- Neonatal encephalopathy
- Permanent brain damage
- Seizure disorders
- Cerebral palsy (CP)
- Intellectual disabilities
- Developmental delays
- Motor disorders
In an earlier piece we discussed pregnancy complications that require an early delivery and at what gestational ages delivery should occur. In this article, we take a more in-depth look at maternal and obstetrical issues that are an indication for preterm delivery.
AWARD WINNING MEDICAL MALPRACTICE ATTORNEYS & BIRTH INJURY LAWYERS HELPING CHILDREN FOR ALMOST 3 DECADES
If your child has hypoxic ischemic encephalopathy (HIE), seizures, cerebral palsy or any other birth injury, email or call the award winning medical malpractice attorneys at Reiter & Walsh ABC Law Centers. Unlike other firms, the attorneys at Reiter & Walsh focus solely on birth injury cases and have been helping children throughout the nation for almost 3 decades. The partners of the firm, Jesse Reiter and Rebecca Walsh, were recently recognized as being two of the best medical malpractice attorneys in America by U.S. News and World Report 2015, which also recognized Reiter & Walsh ABC Law Centers as one of the best law firms in the nation. In fact, U.S. News and World Report has given Mr. Reiter the honor of being one of the “Best Lawyers in America” every year since 2008. Mr. Reiter is the president and founder of ABC Law Centers, a national law firm of medical malpractice attorneys who focus on birth injury cases.
THE IMPORTANCE OF THE WOMB, PLACENTA & UMBILICAL CORD
The fetus develops inside the womb (uterus) during pregnancy and is surrounded by amniotic fluid. The placenta, which is attached to the inside of the womb, helps bring oxygen and nutrients to the fetus from the mother. Oxygen and nutrient-rich blood travels through vessels that run between the uterus and placenta, and this blood is delivered to the baby through the umbilical cord, which arises from the placenta. Conditions that affect the uterus, placenta, umbilical cord and amniotic fluid can cause birth injuries that result in the baby having hypoxic ischemic encephalopathy (HIE), infection, sepsis, meningitis, brain damage, seizures, cerebral palsy and other lifelong conditions.
Described below are some maternal issues that can affect the environment of the unborn baby and thus require early delivery.
HIGH BLOOD PRESSURE / PREECLAMPSIA: DELIVERY AT 36 – 39 WEEKS OR SOONER TO PREVENT INFANT BRAIN DAMAGE
High blood pressure (hypertension) during pregnancy can prevent the placenta from getting enough blood, which means the baby will receive less oxygen and nutrients. Preeclampsia is a more severe form of hypertension, and it is diagnosed when the mother has hypertension that is diagnosed after 20 weeks of gestation along with dysfunction in some major organs.
High blood pressure and preeclampsia increase a baby’s risk of having the following conditions:
- Poor fetal growth
- Intrauterine (fetal) growth restriction (IUGR/FGR)
- Placental abruption
- Premature birth
Preeclampsia poses the additional risks of the mother having kidney failure, a hypertensive crisis, HELLP syndrome, and eclampsia. These conditions are life-threatening for the baby.
The conditions caused by mismanaged hypertension and preeclampsia can result in the baby having birth injuries such as hypoxic ischemic encephalopathy (HIE) and cerebral palsy. In order to prevent brain damage in the baby, certain circumstances require early delivery.
Early Delivery for Babies Affected by Maternal Hypertension and Preeclampsia
Long-term (chronic) maternal hypertension not being treated with medication. In this situation, delivery should occur at weeks 38 – 39. If additional complicating issues are present, such as (IUGR/FGR), preeclampsia, etc., an earlier delivery may be indicated.
Chronic maternal hypertension controlled with medication. This condition requires delivery at weeks 37 – 39. If there are additional complicating issues, such as (IUGR/FGR), preeclampsia, etc., delivery may need to occur at an earlier date.
Chronic maternal hypertension that is difficult to control (requires frequent medication adjustments). In this case, delivery should take place at weeks 36 – 37. If additional complicating issues exist, such as (IUGR/FGR), preeclampsia, etc., an earlier delivery may be indicated.
Gestational hypertension (hypertension that begins during pregnancy). When a mother has this condition, delivery should occur at weeks 37 – 38.
Severe preeclampsia. This condition requires that delivery take place as soon as the mother is diagnosed, as long as the pregnancy is at 34 weeks or later. If additional complicating issues exist, such as (IUGR/FGR), an earlier delivery may be indicated.
Mild preeclampsia. When the mother has mild preeclampsia, the baby should be delivered at 37 weeks. If there are additional complicating issues, such as (IUGR/FGR), delivery may need to occur at an earlier date.
PREGESTATIONAL & GESTATIONAL DIABETES: DELIVERY AT 34 – 39 WEEKS OR SOONER TO PREVENT BRAIN DAMAGE IN THE BABY
Approximately 15% of pregnancies are complicated by gestational diabetes, and 3 – 4 % of pregnant women have pregestational diabetes. Diabetes can cause numerous medical problems, including blood vessel problems, excessive glucose being carried to the baby, and a lack of oxygen in the baby’s brain (hypoxia). Complications associated with gestational diabetes & pregestational diabetes include the following:
- A large for gestational age (LGA) baby and macrosomia, which increase the baby’s risk of having forceps and vacuum extractors used during delivery, shoulder dystocia, brachial plexus injuries, Erb’s palsy and being non-vigorous at birth
- Fetal hypoxia
- Insufficient fetal growth
- Maternal hypertension
- Reduced uteroplacental perfusion (RUPP), which is a condition that decreases blood flow between the mother and fetus
- Preterm delivery (if mother is obese)
- Neonatal hypoglycemia
- Hyperbilirubinemia (prolonged jaundice)
- Respiratory distress
- Cardiomyopathy (baby has a large heart)
- Hypocalcemia, hypomagnesemia, polycythemia
In order to prevent the baby from having brain damage, early delivery is indicated in certain circumstances.
Early Delivery for Babies Affected by Pregestational and Gestational Diabetes
Diabetes that the mother had prior to becoming pregnant (pregestational) that are well-controlled. Late preterm birth or early term birth is not recommended. However, if additional complicating issues exist, such as (IUGR/FGR), preeclampsia, etc., an earlier delivery may be indicated.
Pregestational diabetes coupled with vascular disease. These conditions require that the baby be delivered at weeks 37 – 39. If additional complicating issues are present, such as (IUGR/FGR), preeclampsia, etc., an earlier delivery may be necessary.
Pregestational diabetes that are poorly controlled. This situation requires that delivery take place at 34 – 39 weeks, with specific timing individualized to the mother’s situation. If there are additional complicating issues, such as (IUGR/FGR), preeclampsia, etc., an earlier delivery may be indicated.
Gestational diabetes that are well-controlled with diet or medication. Late preterm birth or early term birth is not recommended for this situation. However, if additional complicating issues exist, such as (IUGR/FGR), preeclampsia, etc., a delivery prior to term may be indicated.
Gestational diabetes that are poorly controlled on medication. This scenario requires that delivery take place at 34 – 39 weeks, with specific timing individualized to the mother’s situation. If there are additional complicating issues, such as (IUGR/FGR), preeclampsia, etc., an earlier delivery may be indicated.
OBSTETRICAL ISSUES SUCH AS PRETERM LABOR OR PREMATURE RUPTURE OF THE MEMBRANES (PROM)
Mothers with preterm labor or premature rupture of the membranes (PROM) may proceed to delivery spontaneously, but this does not always happen. Expectant management is when the mother and baby are closely monitored and delivery is allowed to occur “naturally.” Choriamnionitis (infection of the amniotic fluid and fetal membranes) and umbilical cord compression are very serious conditions associated with preterm labor and PROM. An infection that travels to the baby when the membranes rupture can cause the baby to have sepsis, meningitis, HIE and cerebral palsy. Umbilical cord compression can cause birth asphyxia, HIE and cerebral palsy.
Due to the potential for severe harm if the baby has her cord compressed or gets an infection, expectant management is typically not recommended when late-preterm labor or early-term PROM occur. Experts recommend that obstetricians promptly deliver babies when preterm PROM occurs at or after 34 weeks. Listed below are specific guidelines for preterm labor and PROM.
Early Delivery for Mothers Experiencing Preterm Labor or PROM
The mother had a previous spontaneous preterm birth and is currently experiencing preterm PROM. When this occurs, the baby can be delivered if her gestational age is 34 weeks or older. If there are additional complicating issues, such as (IUGR/FGR), preeclampsia, etc., an earlier delivery may be indicated.
The mother had a previous spontaneous preterm birth and is currently experiencing active preterm labor. Delivery is indicated if there is progressive labor or an additional maternal of fetal indication. If additional complicating issues exist, such as (IUGR/FGR), preeclampsia, etc., an earlier delivery may be indicated.
PLANNED EARLY DELIVERY ALLOWS OBSTETRICIANS TO GIVE IMPORTANT IN-UTERO MEDICATIONS THAT HELP PREVENT BIRTH INJURIES
When preterm birth is about to occur, obstetricians must make every effort to prevent associated problems, such as respiratory distress, sepsis, brain bleeds and PVL. When a baby is at or less than 34 weeks of gestation and the obstetrician is planning a preterm delivery, a steroid such as betamethasone should be given in-utero. Betamethasone has been shown to reduce the incidence and severity of respiratory distress syndrome (RDS), intraventricular hemorrhages (brain bleeds), sepsis and PVL. Steroids such as betamethasone help the baby’s lungs and numerous tissues throughout the body mature.
Another in-utero medication that should be given when preterm birth is about to occur is called magnesium sulfate. This drug helps protect the baby’s brain. Premature babies are at an increased risk for brain injury and cerebral palsy and magnesium sulfate reduces the risk of the baby having cerebral palsy and other major movement disabilities.
Magnesium sulfate helps protect the baby’s brain by the following mechanisms:
- It increases blood flow in the baby’s brain
- It reduces the damaging molecules that are released when a brain insult, such as birth asphyxia, causes brain inflammation
- It has antioxidant effects
- It reduces a process called neuronal excitability, which is damaging to the brain and occurs when the brain experiences an insult
- It stabilizes membranes in the brain
- It prevents large blood pressure fluctuations
Magnesium sulfate is given approximately 24 hours before preterm delivery and it is administered when the baby is between 24 and 32 weeks of gestation. It can be given to women with preterm PROM, preterm labor with intact membranes and indicated preterm delivery.
PLANNED EARLY DELIVERY CAN HELP PREVENT HYPOXIC ISCHEMIC ENCEPHALOPATHY (HIE), NEWBORN BRAIN DAMAGE & CEREBRAL PALSY
Indeed, an early, scheduled delivery can be crucial in preventing birth injuries such as HIE, brain damage and cerebral palsy. Early delivery allows the baby to be delivered before an underlying condition worsens or causes secondary complications. In addition, planned deliveries enable in-utero drugs to be given and important medical treatments such as blood transfusions to be readily available. Planning can also be crucial in ensuring the presence of enough staff and medical equipment to properly care for the mother and baby.
AWARD WINNING MEDICAL MALPRACTICE ATTORNEYS HELPING CHILDREN WITH BIRTH INJURIES FOR ALMOST 3 DECADES
If you are seeking a medical malpractice attorney to help your child, it is very important to choose a lawyer and firm that focus solely on birth injury cases. Reiter & Walsh ABC Law Centers is a national birth injury law firm that has been helping children with birth injuries for almost 3 decades.
Birth injury lawyer Jesse Reiter, president of ABC Law Centers, has been focusing solely on birth injury cases for over 28 years, and most of his cases involve hypoxic ischemic encephalopathy (HIE) and cerebral palsy. Partners Jesse Reiter and Rebecca Walsh are currently recognized as being two of the best medical malpractice lawyers in America by U.S. News and World Report 2015, which also recognized ABC Law Centers as being one of the best medical malpractice law firms in the nation. The lawyers at ABC Law Centers have won numerous awards for their advocacy of children and are members of the Birth Trauma Litigation Group (BTLG) and the Michigan Association for Justice (MAJ).
If your child was diagnosed with a birth injury, such as cerebral palsy, a seizure disorder or hypoxic ischemic encephalopathy (HIE), the award winning medical malpractice attorneys 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 birth injury lawyers are available 24 / 7 to speak with you.
VIDEO: MEDICAL MALPRACTICE ATTORNEYS DISCUSS BIRTH ASPHYXIA & BIRTH INJURIES
Watch a video of birth injury lawyers Jesse Reiter & Rebecca Walsh discussing prevention of birth injuries, which are often caused by medical malpractice.
- Spong, Catherine Y., et al. “Timing of indicated late-preterm and early-term birth.” Obstetrics and gynecology 118.2 Pt 1 (2011): 323.
- Graham EM, Ruis KA, Hartman AL, et al. A systematic review of the role of intrapartum hypoxia-ischemia in the causation of neonatal encephalopathy. Am J Obstet Gynecol 2008; 199:587.