Birth Injuries

Cord prolapse   can be a nightmare for any healthcare professional, specifically when the cord prolapse is ahead of the baby and can actually hang out.  It is a medical emergency. There is only one situation that can be corrected by surgery.  You must take the mom immediately to the operating room.  Health care providers are taught to elevate the umbilical cord off the baby’s head so atleast it won’t be compressed until the surgery can be accomplished.  There is no other way of avoiding damage to the baby other than a stat emergency C-section – if cord prolapse occurs.

In addition to examining the mother to see if the cord has prolapsed, the attending physician can tell if the fetus is suffering distress by examining the fetal heart monitor. Fetal distress can be a sign of a cord prolapse. 

Cord prolapse can also be occult –which means it can be hidden.  Sometimes, despite the examination, the health care provider may not find a cord prolapse.  Nonetheless, if they can determine that there is a certain pattern in the heart rate monitor, they can determine that there is an occult cord prolapse.  If that is the case, labor must not be allowed to continue, and the baby must be delivered surgically.

Different Causes of Cerebral Palsy

Modern science can not explain most incidents of cerebral palsy, the statistic approaches 80% where we do not know what caused it. Where we can decipher a cause, the explanation can often be traced to either trauma, metabolic disorders, infection, and the kind which occurs during labor and delivery.  Actually only about 5-10% of cases of cerebral palsy occur during labor and delivery and obviously not all of these are a physician’s or hospital’s fault.  Only a select few are caused by medical negligence.

The different causes of cerebral palsy that affect various parts of the body obviously affect the brain, and so weather it is due to infection, or trauma or lack of oxygen, or an unknown cause, they each affect a different part of the brain and that is what leads to the cerebral palsy.  Cerebral palsy can manifest in different ways and you may not know it until the child is older.  That is the effects of cerebral palsy are present when the child is born, but as the child gets older and the voluntary movements come out, that is when you realize the full extent of the cerebral palsy.  If an infection is the cause, it may be one sided versus the other side of the brain.  If it was caused due to a lack of oxygen, it usually affects the total brain and will affect the upper and lower extremities.

There are many ways to time a brain injury to a fetus that suffered from Hypoxic Ischemic Encephalopathy (a lack of oxygen or lack of blood flow). This is necessary in mal practice legal cases where determining levels of responsibility will often depend on establishing the sequence of events and timing. The case will often depend upon weather the nurse or doctor or hospital under review had sufficient warning of the events that occurred. If they did, then they should bear responsibility for the subsequent injury to the baby. If they didn’t have warning, they should not be held accountable.

There are various ways you can time a Hypoxic Ischemic Encephalopathic insult to a baby’s brain:

1. Look, when did the baby have seizures;
2. check the laboratory values – specifically nucleated red blood cells;
3. Radiographic studies – sonograms, head MRI’s or CAT scans are useful to help time the injury.

And of course you want to check the fetal heart rate tracings. Because depending upon what the fetal heart tracings show, that can help you time and insult or injury to a baby’s brain. It is usually not one cause in isolation that helps time an injury, but rather a combination of factors. In other words the laboratory factors, the factors involving the radiographic studies, the fetal heart rate tracings, putting all of those factors and others together, help one time when an injury Hypoxic Ischemic Encephalopathic injury occurred during labor and delivery.

The term micro means small, and ceph - refers to the head. Microcephaly can be an acquired condition at birth. The baby can be developing during the nine months of pregnancy perfectly well, the physicians can look at the ultrasound and see the hands, and the legs and feet and the abdomen and specifically the baby’s brain are all developing proportionally and nicely. However a hypoxic ischemic insult – that is a lack of oxygen or lack of blood flow to the brain during labor and or delivery will cause the brain to take a big insult, and that insult will not allow the brain to grow normally anymore, and it will fall off the growth curve later in life.

This condition of acquired Microcephaly is useful to help time an injury if it occurs during labor and delivery. Kids who have hypoxic ischemic encephalopathy – a lack of oxygen or blood flow to the brain during labor and delivery will almost always be born with a normal head size and then later in life their head or brain will fall off the growth curve and they will have Acquired Microcephaly.