Articles Posted in Birth Injuries

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Originally created by Dr. Lawrence Weed in the 1960s as a part of his recommendation for a problem-oriented medical record, a problem list, distilled to its basic form, is a document that states the most important health problems facing a patient, such as illnesses or diseases, injuries suffered, and anything else that has previously affected, or is currently affecting the patient. According to the Journal of American Health Information Management Association (AHIMA), among other things, the problem list was designed to help practitioners identify the most important health factors for each patient, allowing for customized care. However, a recent article entitled, “Problem Lists Can Threaten Safety, Pose Liability Risks,” published by Healthcare Risk Management, illustrates the ongoing problems with problem lists.

A team of researchers led by Adam Wright, PhD, a scientist at Brigham and Women’s Hospital in Boston, studied 10 healthcare organizations that use different electronic health records in the United States, United Kingdom, and Argentina. The study, which was published in the October 2015 issue of the International Journal of Medical Informatics, was designed to see how complete problem lists were at each facility. The investigation revealed staggering levels of completeness varying from 60% to 99%, with an average of 78%.

Larkin v. Johnston, a recent malpractice case out of Massachusetts, illustrates what can happen when a problem list is incomplete. Andrea Larkin, a 28-year-old woman, former school teacher, who ran the Boston Marathon in 2004, suffered a stroke that left her partially paralyzed after childbirth and now requires 24-hour care. The case began with Larkin’s visit to a clinic after running the Boston Marathon and experiencing dizzy spells. Dr. Jehane Johnston ordered an MRI and CT scan which revealed brain abnormalities. Dedham Medical Associates had a specific policy requiring doctors to make note of such abnormal findings in a “problem list,” on the inside cover of Larkin’s medical record. This policy was intended to improve patient safety by bringing the conditions to the attention of any clinician’s review of the chart in the future. Unfortunately, Larkin’s abnormal brain findings were never entered in the problem list, so, when Larkin became pregnant nearly four years later, Larkin’s obstetrician was not aware of her brain issues.  Larkin, who would have been given a C-section had her OB-GYN been aware of her brain abnormalities, was allowed to have a vaginal birth which resulted in a massive stroke just hours after giving birth to her daughter.  Larkin was awarded $35.4 million – over $41 million with interest.

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According to the Centers for Disease Control and Prevention, the number of women dying because of pregnancy and childbirth is going up. More than 25 years ago (1987), there were 7.2 deaths of mothers per 100,000 live births; in 2011, that number more than doubled to 17.8 deaths per 100,000 births.

According to experts reporting on this subject, there is not any one factor to explain the increase, but a number of issues, including obesity related complications, record-keeping changes, age and delayed childbearing, health disparities, and an increase in the number of cesarean section births. One of the causes not mentioned, however, is medical malpractice.

Recently, a family of a 32-year-old woman who died from complications during pregnancy while being treated at the Cooley Dickinson Hospital, filed a lawsuit against the hospital for negligence. According to the complaint, the hospital staff missed signs of pre-eclampsia – a potentially fatal complication of pregnancy – and then failed to timely treat it. The complaint further alleges that after the woman was unresponsive for over 10 hours and had given birth by cesarean section, staff realized she had suffered a massive cerebral hemorrhage and would not recover.

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A7GEAW_2378638bNovember is National Diabetes Awareness Month, so a recent report published in JAMA Pediatrics, revealing that pregnant woman with elevated blood sugar levels are more likely to have babies with congenital cardiovascular defects, even if their blood sugar is below the cut off for diabetes, could not come at a more appropriate time.

The study was conducted over four years out of the Stanford University Medical Center, where researchers examined blood samples taken from 277 California women during their second-trimester of pregnancy. Out of the 277 women, 180 were carrying infants without congenital heart disease, and the others had infants affected by one of two serious heart defects. Specifically, 55 had tetralogy of fallot, where a baby is getting too little oxygen, and 42 had dextrotransposition of the great arteries, where the position of the two main arteries leading form the hart are swamped, preventing oxygenated blood from the lungs to circulate throughout the body.

The women’s levels of glucose and insulin were measured and used to test the association between those levels and the odds of having a baby with a heart defect. The results revealed that women who had fetuses with tetralogy of fallot had higher average blood glucose levels, but there was no significant finding in the relationship between dextrotranspostition of the great arteries and glucose levels.

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According to a recent lawsuit filed in the U.S. District Court of Tennessee, defendant health care providers failed to properly handle the delivery of the minor plaintiff, resulting in extended fetal oxygen deprivation and brain injury at birth. Specifically, the complaint alleges that during the mother’s labor and delivery, medical personnel failed recognize and respond to clear signs of declining fetal response, indicating the need for an emergency C-section.

The mother plaintiff gave birth to her first child via Cesarean section, and shortly thereafter she became pregnant again. According to the lawsuit, despite her risk factors, including short stature; previously unsuccessful attempt at vaginal birth; and a brief time between the two pregnancies; the mother plaintiff was advised that she was a good candidate for a vaginal birth after C-section (VBAC).

The mother plaintiff went into labor early, and within the first half hour the EFM strip indicated minimal variability and loss of accelerations (two signs of fetal compromise). According to the lawsuit, rather than being admitted to the Labor & Delivery ward, the fetal monitoring was stopped and the mother plaintiff was advised to walk around the hospital for an hour or so. About two hours later, she was admitted whereupon labor progression was slow and the fetal monitoring continued to show repetitive late decelerations. After several hours, a C-section delivery was ordered.

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According to a study published this week in the Journal of Pediatrics titled “Prescription Opioid Epidemic and Infant Outcomes,” the use of prescription narcotic painkillers during pregnancy increases the risk that a baby will be born small or early, as well as the risk of drug withdrawal known as neonatal abstinence syndrome.

The study included the analysis of medical records for more than 112,000 women in the Tennessee Medicaid program between 2009 and 2011. Of those women, approximately 28% filled a prescription for at least one narcotic painkiller — mostly short acting medications such as hydrocodone or oxycodone.  According to the authors, prescription narcotic painkillers are “commonly prescribed in pregnancy.”

Babies born small or early are at greater risk for labor and delivery complications, as well as neonatal complications, including:

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World Cerebral Palsy Day is a global innovation project created to improve quality of life for people living with cerebral families, and their families. The project is led by a group of non-profit cerebral palsy charities, and supported by organizations in over 45 countries.

Cerebral palsy is a neurological disorder caused by abnormalities in parts of the brain that control muscle movements, hearing, vision and cognition. It is the most common physical disability in childhood. The majority of children with cerebral palsy were born with it, although the diagnosis may not be made until a child reaches three years of age. According to en.worldcpday.org, at least two thirds of children with cerebral palsy will have movement difficulties affecting one or both arms, 1 in 4 children with cerebral palsy cannot talk, 1 in 3 cannot walk, 1 in 2 have an intellectual disability, and 1 in 4 have epilepsy. In the most severe cases, children born with cerebral palsy will live their lives dependent upon others for every aspect of daily living.

Causes of cerebral palsy include hypoxia or ischemia during childbirth, genetic disorders, stroke, infection and trauma. Where cerebral palsy is caused by a preventable medical error during labor and delivery, the child and his or her family may have a claim for medical malpractice.
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As soon as a baby is born, s/he is forced to make major changes within seconds. The APGAR scoring system was developed so that doctors, such as obstetricians, and hospital nurses can rapidly asses how a newborn is adjusting to life outside of the womb, including evaluation of heart rate, respiration, muscle tone, reflex irritability and skin color.

APGARs are commonly assessed at 1 minute and 5 minutes after birth. Generally, the 1 minute APGAR score is an evaluation of how the baby tolerated the birth process; whereas, the 5 minute score is an evaluation of how the baby is adapting to his/her new environment. Where birth complications lead to a low APGAR score, doctors may also perform a 10 minute assessment.

An APGAR score below 7 is considered low. 10-17% of children with a low APGAR score will go on to develop cerebral palsy. Reasons for a low APGAR score include hypoxia (lack of oxygen), ischemia (lack of blood supply), umbilical cord compression, and fetal distress commonly marked by fetal heart rate decelerations.

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Immediately after birth, a baby’s complexion, pulse rate, reaction when stimulated, muscle tone and breathing are assessed. According to Syracuse birth injury lawyer Michael A. Bottar, these assessment criteria form the APGAR score (which ranges from 0 to 10). Generally, APGAR scores are taken a 1, 5 and 10 minutes of life. A score of 7-10 is normal, a score of 4-6 is low, and a score of 3 or less is critically low.

A low APGAR score may be a sign of a birth injury or birth depression, which may give rise to a medical malpractice lawsuit if an OBGYN and/or nurse did not take appropriate steps to prevent fetal hypoxia (low oxygen) and/or ischemia (low blood flow). According to a recent study of more than 500,000 babies born in Norway, children born with an APGAR of 3 or less were 100 times more likely to be diagnosed with cerebral palsy by age 5 when compared to babies born with an APGAR of 10.

Cerebral palsy is a group of disorders that affect movement, cognitive function, vision, hearing and speech. About 2-3 children in 1,000 are affected. Symptoms can range from mild to severe. In the worst cases, children born with cerebral palsy will live their entire lives dependent upon others for every aspect of daily living. Typically, cerebral palsy is caused when insufficient oxygen reaches the fetus. Sometimes oxygen deprivation is preventable. Where a medical provider fails to prevent oxygen deprivation, a birth injury lawsuit may be necessary to secure compensation essential to providing lifelong medical care for a permanently disabled child.

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According to Watertown birth injury lawyer Michael A. Bottar, with the Syracuse medical malpractice law firm of Bottar Leone, PLLC, the Cerebral Palsy Family Health Care Center, operated by the Cerebral Palsy Association of the North Country, has changed its name to the Community Health Center of the North Country.

The Health Center’s executive director stated in a press release that the center welcomes the “uninsured, underinsured, and those with Medicaid, and we hope that the name change will help get the word out that we are open to all community members.” In addition to providing medical care to Watertown individuals and children diagnosed with cerebral palsy, the Community Health Center of the North Country also provides a constellation of services in St. Lawrence County, including primary care, dental care, physical therapy, optometry and mental health services, to individuals with similar disabilities and service needs.

Cerebral palsy is a general term used to describe a group of movement or posture disorders that arise out of the brain’s ability to control the body. Cerebral palsy can be caused by an injury during birth, such as hypoxic ischemic encephalopathy.

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As Syracuse birth injury lawyers handling many cases where a baby was born with the umbilical cord wrapped around its neck, we are often asked by clients and potential clients whether the umbilical cord harmed their baby. This common occurrence is known as a “nuchal cord” and our answer, usually, is no it did not.

One thing to keep in mind is that an unborn baby does not obtain oxygen through the nose or mouth like adults. In turn, some compression on the baby’s neck will not have the same “strangulation” effect as a noose would on an adult. However, where an umbilical cord is tightly wrapped all the way around a baby’s neck (a “Type A” nuchal cord), sometimes two or three times, or becomes knotted (a “Type B” nuchal cord), it can result in injury to the baby if the function of the cord is compromised. While the umbilical cord is wrapped with a gristle-like protective material called “Wharton’s Jelly,” simply stated, if the cord is compressed or stretched too much, the flow of blood and oxygen to the baby may decrease, leading to hypoxia/ischemia and brain damage which may be marked by low APGAR scores at birth.

A nuchal cord is present in as many as 37% of pregnancies. Most of the time, it resolves the same way it occurred – with fetal movement. As a nuchal cord may be associated with a potentially serious complication known as umbilical cord prolapse, where the umbilical cord drops passes into the cervix and vagina before the baby (increasing the risk of compression when the baby subsequently passes through the birth canal), doctors should not ignore the position of the umbilical cord and may be liable for medical negligence if they do not take appropriate steps to prevent umbilical cord compromise.
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