Medical Malpractice Attorneys Discuss Scheduled Preterm Delivery of a High-Risk Pregnancy to Prevent Birth Injuries such as Cerebral Palsy
A scheduled preterm delivery is sometimes indicated in order to prevent harm to the baby caused by sub-optimal obstetrical and medical conditions. When standards of care for the timing and management of early delivery are followed, a preterm birth can help prevent serious birth injuries. Obstetricians 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, the mother should be referred to a maternal-fetal specialist and her prenatal testing should occur more frequently than normal. Obstetricians must look closely for signs of any problems that can be harmful to or risky for the baby. Pregnancy issues that can bet injurious 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 oxygen deprivation (birth asphyxia). When not properly managed, these pregnancy issues can cause the following birth injuries:
- 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
AWARD WINNING BIRTH INJURY & MEDICAL MALPRACTICE ATTORNEYS HELPING CHILDREN FOR ALMOST 3 DECADES
If your child has 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. Birth injury lawyers 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 work to help babies, children and their families.
THE IMPORTANCE OF THE WOMB, PLACENTA & UMBILICAL CORD
The baby 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 baby 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. Problems that affect the uterus, placenta, umbilical cord and amniotic fluid can cause harm to the baby 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 fetal issues that can affect the environment of the unborn baby and thus require early delivery.
INTRAUTERINE (FETAL) GROWTH RESTRICTION (IUGR/FGR): EARLY DELIVERY TO PREVENT BRAIN DAMAGE IN THE BABY
Intrauterine growth restriction (IUGR), also called fetal growth restriction (FGR), is a term used to describe an unborn baby who has an estimated weight that is less than the 10th percentile for gestational age. In other words, the baby is smaller than she should be because she is not growing at a normal rate in the womb. IUGR has many causes, but the condition is most often caused by an insufficient oxygen supply getting to the baby or poor maternal nutrition, both of which can be caused by placental insufficiency. It is very important for physicians to recognize conditions that can cause IUGR. In addition, assessing a baby’s growth is an important part of prenatal care; physicians must be aware of any growth problems in the baby.
Babies that have intrauterine growth restriction are at risk of experiencing conditions such as the following:
- Hypoxic ischemic encephalopathy (HIE)
- Brain damage
- Cerebral palsy
- Seizure disorders
- Intellectual disabilities
- Developmental delays
Prenatal care of a baby with IUGR involves determining the cause and severity of the growth restriction, close monitoring of the baby’s well-being, consultation among different specialists, and selecting the appropriate time for and method of delivery. Listed below are delivery indications for babies with IUGR.
IUGR: Timing Of Delivery
- When a baby has IUGR and no other complicating conditions, deliver should occur at 38 – 39 weeks.
- Delivery should occur at 34 – 37 weeks if the baby has IUGR and a complicating condition or conditions, such as the following:
- Regardless of gestational age, quick emergency C-section delivery should take place if there is persistent abnormal fetal testing suggesting imminent fetal jeopardy.
- When twins are affected by IUGR, delivery should occur at weeks 36 – 37 if the twins are dichorionic-diamniotic and have no complicating conditions.
- Delivery should be scheduled for weeks 32 – 34 if the twins are monochorionic-diamniotic with no complicating conditions.
- If any type of twins have complicating conditions, delivery should take place at 32 – 34 weeks. Complicating conditions include:
- Maternal risk factors
- Abnormal Doppler studies
- Any long-term disease process.
- Regardless of gestational age, twins must have a prompt emergency C-section delivery if there is persistent abnormal fetal testing indicating imminent fetal jeopardy.
MULTIPLE GESTATIONS (TWINS, TRIPLETS OR MORE): EARLY DELIVERY TO PREVENT NEWBORN BRAIN DAMAGE
Multiple gestation is associated with a higher risk of numerous pregnancy complications. The most serious complication is spontaneous preterm delivery, and twins are at a high risk of experiencing intrauterine (fetal) growth restriction. Monochorionic twins are at risk of a complication called twin-to-twin transfusion syndrome, which is when blood vessels of the two fetuses are connected and one fetus gets more blood flow than the other from the shared placenta. Fetuses involved in pregnancies with multiple babies are at risk of being small for gestational age (SGA) and having discordant growth.
Problems associated with multiple gestations include the following:
- Spontaneous preterm delivery, premature rupture of the membranes (PROM)
- Infection, which can cause sepsis, meningitis, brain damage, HIE and cerebral palsy
- IUGR (twins)
- Meconium aspiration
- Discordant growth
- Birth asphyxia
- Hypoxic ischemic encephalopathy. HIE usually involves damage to the basal ganglia and watershed regions of the brain, but sometimes also includes periventricular leukomalacia (PVL)
- Periventricular leukomalacia (PVL)
- Cerebral palsy
- Intellectual disabilities
Babies in a multiples pregnancy are at risk for needing medical intervention as soon as they are born such as resuscitation, cardiovascular support, respiratory support, blood transfusions and even surgery. Thus, a pediatric team should be present at the delivery so that each baby has a team of medical specialists ready to quickly provide care. In addition, blood products and other potential medical treatments should also be ready. Having a team and critical treatments ready is one of the advantages of a scheduled early delivery. In addition, the babies can be given important in-utero drugs that must be given shortly before birth to help prevent birth injuries and brain damage. Infection in the baby is also a major risk of spontaneous pre-term birth, and preventing PROM by having a scheduled delivery can decrease the babies’ risk of infection. Furthermore, if one or more of the babies isn’t getting the oxygen and/or nutrients she needs, an early delivery may be required to prevent the baby from becoming brain damaged. Listed below are delivery indications for twins, triplets or more.
Multiple Gestations: Timing of Delivery
- If the multiples are dichorionic-diamniotic, delivery should take place at 38 weeks. If there are additional complicating factors, such as placental abruption, IUGR/FGR, preeclampsia, etc., delivery may need to occur earlier.
- If the multiples are monochorionic-diamniotic, delivery should occur at 34 – 37 weeks of gestation. If there are additional complicating factors, such as IUGR/FGR, preeclampsia, etc., delivery may need to occur closer to week 34, maybe sooner.
- If the multiples are dichorionic-diamniotic or monochorionic-diamniotic with a single fetal death, delivery should take place right away, if the death occurred at or after 34 weeks. If the death occurs before week 34, the delivery should be individualized based on maternal and fetal conditions. Complicating factors, such as IUGR/FGR, preeclampsia, etc., may require a prompt delivery, even at a gestational ages less than 34 weeks.
- If the multiples are monochorionic-monoamniotic, delivery should occur at weeks 32 – 34. If additional complicating factors are present, such as IUGR/FGR, preeclampsia, etc., delivery may need to occur earlier.
- If the multiples are monochorionic-monoamniotic with a single fetal death, delivery should be considered and individualized, with gestational age and other complicating issues taken into consideration. Additional complicating factors, such as IUGR/FGR, preeclampsia, etc., may necessitate a prompt delivery.
OLIGOHYDRAMNIOS: EARLY DELIVERY TO PREVENT INFANT BRAIN DAMAGE
Oligohydramnios is a condition characterized by an abnormally low amount of amniotic fluid. It is associated with a lack of oxygen to the baby’s brain, abnormal nonstress tests, non-reassuring fetal heart rates (especially decelerations), fetal intolerance to labor, meconium aspiration and low Apgar scores. Oligohydramnios coupled with intrauterine (fetal) growth restriction is an ominous pregnancy condition.
Oligohydramnios is often a sign that the placenta is not functioning properly, and a scheduled delivery should take place before the baby is harmed by complications associated with the condition, such as umbilical cord compression or placental dysfunction.
Oligohydramnios: Timing of Delivery
- Delivery should occur at weeks 36 – 37. If additional complicating factors are present, such as IUGR/FGR, preeclampsia, etc., delivery may need take place earlier.
A PLANNED EARLY DELIVERY ALLOWS PHYSICIANS TO GIVE IMPORTANT IN-UTERO MEDICATIONS THAT HELP PREVENT BIRTH INJURIES
When preterm birth is about to occur, physicians must make every effort to prevent the 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 physician is planning a preterm delivery, a steroid such as betamethasone should be given to the mother to help the baby. 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 tissue 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 directly and indirectly protects the baby’s brain. Premature babies are at an increased risk for brain injury and cerebral palsy. Magnesium sulfate significantly increases the chance that the baby will be born free of cerebral palsy and other major movement disabilities.
Listed below are the benefits of magnesium sulfate:
- 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 (excitotoxicity), 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 about 24 hours before preterm delivery and it is administered when the baby is between 24 and 32 weeks of gestation. Magnesium sulfate can be given to women with preterm premature rupture of membranes (PPROM), preterm labor with intact membranes and indicated preterm delivery.
PLANNED EARLY DELIVERY TO PREVENT HYPOXIC ISCHEMIC ENCEPHALOPATHY (HIE), NEWBORN BRAIN DAMAGE & CEREBRAL PALSY
Indeed, an early, planned delivery can be crucial in preventing injury in the baby caused by uteroplacental insufficiency, a sub-optimal uterine environment, and umbilical cord, placental and uterine emergencies. Early delivery can also allow 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 to be readily available. Planning is can also be crucial in ensuring the presence of enough staff to care for the mother and baby or babies.
AWARD WINNING MEDICAL MALPRACTICE ATTORNEYS / BIRTH INJURY LAWYERS HELPING CHILDREN 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. Medical malpractice attorneys 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 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 medical malpractice lawyers are available 24 / 7 to speak with you.
VIDEO: BIRTH INJURY LAWYERS DISCUSS BIRTH ASPHYXIA, BIRTH INJURIES & BRAIN DAMAGE IN A BABY
In this video, medical malpractice attorneys Jesse Reiter & Rebecca Walsh discuss the causes of birth asphyxia, birth injuries and brain damage in a baby and how these injuries can be prevented.
- 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.