The hypoxic-ischemic encephalopathy lawyers at ABC Law Centers secured a $6.159 million verdict for a baby with permanent brain injury due to medical staff’s failure to perform a C-section on time and failure to address the umbilical cord wrapped around the baby’s neck.
A baby girl was deprived of oxygen around the time of delivery and suffered a stroke and permanent brain injury because physicians failed to perform a cesarean section when the baby was in distress. Instead, the physician used a vacuum extractor to assist with vaginal delivery, even though use of this device was against the standard of care in this case. Use of a vacuum extractor is risky, and when physicians violate the standard of care while using it, the risks to the baby are increased even further. The baby had a very fast heart rate (tachycardia) which can be indicative of a major problem. There was, in fact, no physician present during the first 2.5 hours or more of labor, and nobody skilled at fetal heart rate interpretation was watching the fetal heart rate monitor. This is especially appalling considering the fact that this pregnancy was labeled high risk. When the physician finally arrived and began to assist with labor, the baby was having a problem with her umbilical cord: it was wrapped around her neck (nuchal cord). Although a nuchal cord is fairly common, continuing with a vaginal delivery was very risky because descent during labor can cause the cord to get tighter and tighter, thereby further decreasing the oxygen going to the baby and causing hypoxic ischemic encephalopathy (HIE). The little girl suffered a stroke, causing her brain to be deprived of oxygen. A C-section delivery should have been performed much earlier to prevent this little girl from experiencing HIE, permanent brain damage and cerebral palsy.
The Importance of Fetal Heart Rate Monitoring & Prompt C-Section Delivery when the Baby is in Distress
When a mother is in labor, the baby’s heart rate must be monitored with a fetal heart rate monitor. It is equally important that someone very skilled at interpreting the heart tracings be available to review the tracings either continuously or frequently, depending on the stage of labor and the condition of the mother and baby. Since this was a high risk pregnancy and the baby had some non-reassuring heart tracings, it was critical that a physician skilled in heart rate interpretation be present during labor. In addition, the mother was given Pitocin to speed up labor and delivery, and this is risky drug that can cause oxygen deprivation in the baby. When Pitocin is given, it is critical to closely monitor the baby’s heart tracings.
In this case, the baby was experiencing tachycardia, which can be an ominous sign during labor and delivery. Tachycardia requires very close monitoring, and if the tachycardia is indicative of a baby’s condition getting progressively worse, intervention is required. If vaginal delivery cannot safely occur immediately, a prompt C-section delivery should be performed. The goal is to deliver the baby so that she is out of oxygen depriving conditions – especially before severe or complete deprivation occurs.
Nuchal cords can cause non-reassuring heart tracings. In this case, the tachycardia wasn’t even recognized during labor because the nurses weren’t skilled at interpreting the tracings. No physician was monitoring the baby for over 2.5 hours. Had a C-section occurred, the baby’s stroke could have been prevented. Experts in this case agreed that the stroke occurred near the time of or during delivery.
How a Nuchal Cord can cause Birth Asphyxia, HIE & Cerebral Palsy
A nuchal cord can deprive a baby of oxygen in multiple ways. It can be so tight around the neck that it restricts blood vessels in the neck, thereby reducing blood flow to the brain. The cord can also be compressed or impinged upon, which causes a decreased flow of oxygen-rich blood to the baby. Indeed, a nuchal cord can cause a low circulating blood volume in the baby which then causes a low blood pressure, which can lead to a stroke. There different ways of managing a nuchal cord. If a vaginal delivery is about to occur, there are maneuvers that can be done to try and loosen the cord. Nuchal cords are associated with fetal demise, and descent through the birth canal can make the cord tighter. Thus, if vaginal delivery is not imminent, the baby should be delivered by emergency C-section. The medical team can diagnose a nuchal cord by using an ultrasound, but the bottom line is that if the baby’s heart rate is non-reassuring, delivery should quickly occur.
A fetal stroke can be caused by anything that causes blood flow in the baby’s brain to be blocked or restricted. The term “stroke” refers to the breakage or blockage of a blood vessel in the brain. A decrease in blood flow caused by a nuchal cord and a brain bleed caused by a vacuum extraction delivery can both lead to the baby having a stroke. A fetal stroke deprives part of the brain of oxygen and it is one of the most common causes of cerebral palsy in term and near term infants. The nuchal cord and the vacuum extractor both could have caused this little girl’s cerebral palsy. Had delivery occurred much earlier by C-section the stroke would have been prevented.
Dangers of a Vacuum Extractor Delivery
The standard of care dictates that a vacuum extractor only be used when certain obstetrical conditions and prerequisites are met. One of the prerequisites is that the mother’s cervix be fully dilated, and in this case, the mother was not fully dilated. Thus, a vacuum extractor was against the standard of care. In addition, extracting a baby through the birth canal in this way can cause a nuchal cord to get tighter, which could have caused the baby’s stroke.
Vacuum extractors increase the risk of stroke and brain bleeds, the most serious being a subgaleal hemorrhage. Strokes and brain bleeds can be life threatening and cause permanent brain damage.