Obstetrical Malpractice

Published on: February 3, 2011

Study About How To Prevent Cerebral Palsy In Infants Reviewed by New York Birth Injury Lawyers

Cerebral palsy is a term used to cover a group of brain and nervous system disorders affecting 10,000 babies annually. About 50% of all cerebral palsy cases involve full-term or near full-term infants. According to the American Medical Association, there are ways to prevent cerebral palsy in full-term and premature infants.

One way to prevent CP in a full-term infant is to prevent chorioamnionitis. Chorioamnionitis is an inflammation or infection in the amnion and/or chorion, the membranes that surround and protect a fetus before birth. It affects 1-10% of term births and is often associated with prolonged labor.

Risk factors for chorioamnionitis include: prolonged labor, maternal age (less than 21 years old), prolonged rupture of membranes, first pregnancy, and multiple vaginal examinations during labor. If it is timely diagnosed (typically after a mother exhibits a fever, increased heart rate, uterine tenderness and/or foul smelling amniotic fluid), chorioamnionitis can be treated with intravenous antibiotics (usually ampicillin or clindamycin, plus gentamicin). Undiagnosed chorioamnionitis, which may be the result of medical malpractice, can lead to serious complications including bacteremia, meningitis and respiratory distress syndrome which, depending upon the severity, can restrict fetal oxygenation and lead to cerebral palsy.

In preterm infants, administering a drug called magnesium sulfate 24 hours before delivery may also reduce the risk of cerebral palsy. Studies suggest that “mag sulfate” has a neuroprotective effect.
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Published on: January 26, 2011

Medical Malpractice NY: Birth Injury Risk High During Nightime and Weekend Labor and Delivery

By Bottar Law, PLLC

“Bottar Law, PLLC is presently handling several New York birth injury cases involving permanent disabilities caused by new york obstetrical malpractice and labor and delivery nurses errors made during a nighttime labor and delivery,” said Syracuse birth injury attorney Michael A. Bottar, Esq. “Certainly, the outcome of a birth is linked to the time of day a baby is born.”

An article published in the Journal of Obstetrics and Gynecology entitled “The Night—A Dangerous Time To Be Born?,” reported that babies were twice as likely to sustain a birth injury if born during the night (between 7:00 p.m. and 6:59 a.m.), as compared to a daytime birth (between 7:00 a.m. and 6:59 p.m.). A Queensland study
entitled “The Impact of Time of Delivery On Perinatal Outcomes,” reported additional troubling statistics. That is, that fetal death rates were highest between 1:00 a.m. and 2:59 a.m. Of note, was that the rate of fetal death was lowest between 11:00 a.m. and 12:59 p.m., and the rate of neonatal death was lowest between 5:00 p.m. and 6:59 p.m.

A German study reported in 2003 linked nighttime delivery dangers to the delivery of substandard medical care, also known as obstetrical medical malpractice and labor and delivery mistakes.According to The March of Dimes, low birth weight babies are at high risk for respiratory distress syndrome (i.e., RSD), intraventricular hemorrhaging (i.e., bleeding in the brain), patent ductus arteriosus (i.e., PDA), necrotizing enterocolitis (i.e., NEC), and retinopathy of prematurity (i.e., ROP).
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Published on: January 7, 2011

Link Between Newborn Jaundice, Epidural Anesthesia and Oxytocin Reviewed By Syracuse New York Birth Injury Lawyer

By Bottar Law, PLLC

Jaundice, which is the clinical manifestation of hyperbilirubinemia (too much bilirubin in the blood), occurs in about one-half of term newborns as well as most premature babies (85%). Elevated bilirubin levels are also associated with low birth weight babies, sepsis, delivery requiring instrumentation, and history of maternal diabetes.

“Hyperbilirubinemia is also associated with epidural anesthesia and Oxtyocin,” said Syracuse birth injury lawyer Michael A. Bottar, Esq., of Bottar Law, PLLC. “Epidural anesthesia is the most popular mode of pain relief during labor and, while it is widely believed that regional anesthetics present little if any risk to an unborn baby, this is not true in all cases.” Epidural anesthesia is associated with fetal respiratory depression, decreased fetal heart rate, fetal malpresentation, and difficulty breastfeeding after birth. Likewise, Oxytocin (i.e., Pitocin) may also cause hyperbilirubinemia.

Where a pregnant mother receives an epidural, or where labor is augmented by Oxytocin to stimulate contractions, the obstetrician and labor and delivery nurses should be on alert for newborn hyperbilirubinemia Neonatologists and pediatricians should also conduct appropriate surveillance by testing serum bilirubin levels.

While too much bilirubin in a baby’s blood is easily treated by phototherapy (or an exchange transfusion in severe cases), it can lead to permanent brain damage if the diagnosis is not made early. Baby brain damage caused by exposure to too much bilirubin is known as kernicterus. Kernicterus can cause cerebral palsy and other permanent disabilities such as long-term hearing loss, behavioral problems, and bilirubin induced neurological dysfunction (BIND).
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Published on: January 5, 2011

Failure To Diagnose Gestational Diabetes Is Common New York Medical Malpratice

By Bottar Law, PLLC

“The failure to diagnose gestational diabetes during pregnancy is a big problem,” said Syracuse birth injury lawyer Michael A. Bottar, Esq., of Bottar Law, PLLC, a legal team representing the catastrophically injured throughout the State of New York.

4-12% of pregnancies are complicated by gestational diabetes. A recent study of 900,000 American women published in Obstetrics and Gynecology reports that as many as 1 in 3 pregnant women are not receiving a simple laboratory test to check for diabetes mellitus, also known as gestational diabetes. The failure to test for and the failure to diagnose gestational diabetes is obstetrical malpractice that places a pregnant mother and her baby at risk for complications, including preeclampsia, premature birth, macrosomic babies and neonatal hypoglycemia. Where timely diagnosed, gestational diabetes can be treated by controlling glucose by diet, as well as exercise and insulin.

The study titled Gaps In Diabetes Screening During Pregnancy and Postpartum also revealed that as many as 1 in 5 pregnant women who developed gestational diabetes while pregnant were screened for diabetes within 6 months after pregnancy. This means that many pregnant mothers developed diabetes that had gone undiagnosed and untreated for a significant period of time after birth. This is well below the standard of care, as current medical guidelines require that women with gestational diabetes be tested for diabetes 6 to 12 weeks after delivery.

The study also revealed that obese women, who have the highest risk for developing gestational diabetes, were the least likely to be tested. Women weighing more than 275 pounds were 12% less likely to receive testing, but were 348% more likely to have gestational diabetes. Women weighing more than 300 pounds were 6% less likely to receive testing, but were 300% more likely to have gestational diabetes.
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Published on: December 14, 2010

New York Birth Injuries From Fetal Distress May Decline With AirStrip OB

By Bottar Law, PLLC

Many babies are diagnosed with cerebral palsy and other birth injuries due to a period of fetal distress during labor and delivery. “Every year, our legal team investigates claims arising out of a failure to respond to dangerous decelerations recorded on fetal heart monitor tracings,” said Syracuse birth injury lawyer Michael A. Bottar, Esq., of Bottar Law, PLLC, a law firm with a practice limited to medical malpractice and catastrophic injury cases throughout the State of New York.

“Historically, obstetricians and labor and delivery nurses had to review fetal heart monitor tracings in a specific location, whether it was at the bedside or on a remote computer monitor,” Bottar said. When these individuals are unavailable, timely and appropriate review of the tracings can overlooked and even minutes of delay can lead permanent disability, including cerebral palsy, Erb’s palsy and global developmental delays.

Recently, a monitoring system was released that allows obstetricians to monitor the vital signs of a laboring mother and unborn baby through a smart phone application known as AirStrip OB. The system, which is being tested at Summit Medical Center in Tennessee, delivers various vital signs including fetal heart rate and maternal contractions in real-time. The application also affords doctors an opportunity to review nursing notes.

“AirStrip OB is a great development. It should cut down on the number of missed opportunities to prevent a birth injury stemming from, e.g., insufficient oxygen (hypoxia) or poor blood flow (ischemia). Soon, all busy obstetricians will need to do to avoid malpractice is look at their iPhone to see – instantly – how a labor is progressing. Or, more importantly, if it is not proceeding as planned. As the fetal brain can be permanently damaged in minutes, it is encouraging to know that help for a struggling baby may now been only a phone call away.”
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Published on: December 4, 2010

Birth At Night Increases Cerebral Palsy Risk From Baby Brain Injury In Syracuse New York

By Bottar Law, PLLC

Syracuse birth injury lawyer Michael A. Bottar, Esq., an attorney with Bottar Law, PLLC, a team of New York cerebral palsy attorneys, reports that the findings of a new study suggest that children born at night are at greater risk for being diagnosed with “neonatal encephalopathy,”

“Neonatal encephalopathy is a rare brain disorder marked by symptoms including abnormal consciousness, tone, reflexes, breathing and feeding. It can lead to cerebral palsy or epilepsy,” said Bottar. According to a study published in the November edition of the American Journal of Obstetrics & Gynecology, babies born between the hours of 10 p.m. and 4 a.m. were 22% more likely to experience a brain problem. The study examined more than 2,000,000 births over a period of 14 years.

Prior studies have linked birth injuries to night time deliveries, with some suggesting that medical residents (i.e., new doctors), tired obstetricians, and understaffed hospital labor and delivery units may contribute to New York labor and delivery complications, including fetal distress, low APGAR scores from hypoxia and hypoxic ischemic encephalopathy, which may form the basis of a New York birth injury lawsuit seeking compensation for permanent disability, such as cerebral palsy or persistent pulmonary hypertension of the newborn (PPHN).

Conditions like cerebral palsy and PPHN typically are caused by an injury to the infant’s brain that can occur before, during, or shortly after birth. When a baby’s brain does not receive enough oxygen, it can sustain permanent damage that can lead to seizures, global developmental delays, cognitive impairment, loss of vision, and other life-long disabilities.
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