Hypoxic Ischemic Encephalopathy (HIE) Caused By Pitocin and Cytotec Errors

How Is Hypoxic Ischemic Encephalopathy Caused by Pitocin or Cytotec?

The birth injury attorneys at Reiter & Walsh ABC Law Centers have helped dozens of families affected by hypoxic ischemic encephalopathy (HIE). Attorney 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).

Hypoxic Ischemic Encephalopathy (HIE), or birth asphyxia, is a condition whereby insufficient oxygen in the baby’s brain causes cellular death and brain damage.  Oxygen deprivation typically is due to a lack of oxygen in the baby’s blood (hypoxemia / hypoxia) and/or restricted blood supply (ischemia) to the brain tissue.  Hypoxia and ischemia can occur before, during or after birth, and can have long-term consequences for the baby, such as cerebral palsy, seizures, learning disabilities, developmental delays, and white and gray matter brain damage.   In general, the longer a baby is hypoxic or ischemic, the more severe and permanent the injury.  Injury depends on the severity of the insult and the maturity of the brain tissue affected.

Brain damage may be evident on head imaging studies of the baby’­s brain within 12 to 24 hours of the hypoxic ischemic insult.  On the other hand, abnormal findings may not become apparent for several years.  In a study of school-aged children with moderate to severe HIE, 15 – 20% had significant learning disabilities, even in the absence of obvious signs of brain injury.

Due to the potential for devastating, permanent injury, it is imperative that every effort be made by physicians to prevent hypoxia and ischemia in a baby.  Complications involving labor induction drugs are a common source of hypoxic ischemic injury in the newborn.

Pitocin and Cytotec Can Cause Hypoxic Ischemic Encephalopathy (HIE)

Pitocin (oxytocin) and Cytotec are drugs used to induce or augment labor, although Cytotec is not approved for this use.  Cytotec is a pill that is inserted vaginally to induce uterine contractions and the ripening (effacement or thinning) of the cervix.

Pitocin can be administered intravenously during the birthing process to initiate uterine contractions, and to increase the frequency and strength of contractions.  Pitocin, however, does not work well when the cervix is not ripe, and sometimes is used in conjunction with Cytotec.

The use of these drugs can be very risky, especially if they are used together.  Some of the serious risks associated with them include hyperstimulation and hypertonicity of the uterus, as well as uterine rupture.

Uterine Hyperstimulation and Hypoxic Ischemic Encephalopathy (HIE)

hyper stimulation; uterine hyper stimulation; contractions; placental detachment; placental abruption; hypoxic ischemic encephalopathy, HIE; birth asphyxia; neonatal encephalopathy, intrapartum asphyxia; fetal oxygen deprivation

Hyperstimulation of the uterus, or tachysystole, occurs when contractions are excessive or abnormal.  Hyperstimulation is a complication of Pitocin and Cytotec, and it can seriously hinder the flow of blood through the umbilical cord, thereby causing oxygen deprivation in the baby.  Hypertonicity occurs where there is no rest in between contractions, which also interferes with oxygen delivery to the baby.

Hyperstimulation and hypertonicity can have a substantial impact on the placenta.  The placenta is attached to the uterus, and it is the organ from which the umbilical cord arises.  Oxygen-rich blood is transferred to the baby through the placenta.  Between contractions, the placenta fills with the mother’s blood and is relayed to the baby through the umbilical cord.  When the uterus contracts, the flow of blood in or out of the placenta slows or stops.  Between contractions, the placenta is “at rest” and blood flows freely.  For the placenta to function properly, there must be sufficient time between contractions for the placenta to recharge with a fresh supply of oxygen-rich blood.

Hyperstimulation and hypertonicity induced by Pitocin or Cytotec can cause contractions to occur less than 2-3 minutes apart, thereby hindering the placenta’s ability to recharge with a fresh supply of oxygen-rich blood.  With each contraction, the oxygen saturation in the baby’s blood can get lower and lower.  Indeed, research shows that hyperstimulation and hypertonicity induced by Pitocin can cause the oxygen saturation to become progressively worse.

When oxygen saturation in the baby’s blood drops, there often isn’t sufficient oxygen reaching the baby’s brain.  When the infant brain is starved of oxygen, a cascade of cellular events can occur that lead to cell death and HIE.  On an MRI, HIE can be seen as damage to the white and/or gray matter of the brain, and sometimes fluid in the brain (edema) also can be seen.  HIE is one of the most common causes of cerebral palsy and other types of brain damage, including periventricular leukomalacia (PVL).

When hyperstimulation occurs, the physician must stop the administration of Pitocin.  Cytotec, on the other hand, cannot readily be discontinued because the pill is absorbed by vessels in the mother’s vagina.  Both drugs are risky because there is no way to predict how a woman will tolerate these types of labor induction.  The effects of any given dose vary widely; they can range from excessive and severe contractions and fetal asphyxia to absolutely no discernable effect on uterine contractility.  And there are no precise methods of measuring the effects of Pitocin and Cytotec on the uterus, with both internal and external fetal monitoring devices leaving much to be desired.

One sign of fetal distress is heart rate changes on the fetal monitor, such as persistent decelerations (decrease in heart rate below the baby’s baseline) and tachycardia (fast heart rate).  Fetal distress is almost always a sign that the baby is being deprived of oxygen.  When distress occurs, the baby usually needs to be delivered immediately by an emergency C-section.

Uterine Hyperstimulation, Uterine Rupture, and Hypoxic Ischemic Encephalopathy (HIE)

Hyperstimulation can cause one of the most serious pregnancy complications, a rupture of the uterus.  Uterine rupture happens when excessive contractions associated with hyperstimulation cause the uterus to tear, either partially or completely.  This is dangerous because it can cause severe oxygen deprivation in the baby by either causing the mother to lose so much blood that she is unable to supply enough to the baby, or by causing the umbilical cord or placenta to tear away from the uterus, thereby severing the baby’s connection to blood and oxygen from the mother.  When uterine rupture occurs, the baby is at risk for HIE.

Guidelines for Pitocin and Cytotec Use

Due to the precarious nature of labor induction drugs and their potential to cause devastating complications such as HIE, it is imperative that physicians follow standards of care when administering these medications.

Guidelines that must be followed for labor induction include the following:

  • Induction of labor is indicated when continuing the pregnancy is thought to be associated with greater maternal or fetal risk than intervention to deliver the pregnancy.  In addition, there must be no contraindication to vaginal birth.
  • When considering labor induction, the mother should be given a Bishop Score.  This is a scoring system used to help determine if the induction of labor will be successful.  It is the best available tool for predicting the likelihood that induction will result in a vaginal delivery.
  • Contraindications for labor induction drugs include the following:
  • Significant cephalopelvic disproportion (CPD)
  • Hypersensitivity to oxytocin or any component of the formulation
  • Unfavorable fetal positions, such as a breech position
  • Fetal distress when delivery is not about to happen
  • Hypertonic and hyperactive uterus
  • A contraindicated vaginal delivery, such as active genital herpes, prolapse of the cord, cord presentation, total placenta previa or vasa previa
  • Obstetrical emergencies where surgical intervention is favored
  • Where adequate uterine activity fails to achieve satisfactory progress

Pitocin, Cytotec, Hypoxic Ischemic Encephalopathy and Medical Malpractice

Pitocin and Cytotec have long been recognized as dangerous, and researches have concluded that a fetus’s well-being may be in jeopardy when Pitocin induced hyperstimulation occurs during labor.  It therefore is crucial for Pitocin and Cytotec to be used conservatively, and standards of care must be followed at all times.  Careful, continuous fetal monitoring is essential.  Furthermore, these labor induction drugs should only be used for non-elective, emergency induction of labor.  If the physician does not act in a manner consistent with these guidelines, it is negligence.  If this negligence results in injury to the baby or mother, it is medical malpractice.

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 lawyers are available 24 / 7 to speak with you.


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