Doctors and nurses who take care of pregnant mothers assign patients to "high-risk" or "low-risk" categories, which are designed to focus attention on those mothers or infants who develop maternal or fetal conditions that may increase the risk of an adverse outcome. The term "high-risk" implies that: (1) either the mother or the fetus, requires more intensive monitoring during the pregnancy and/or during labor and delivery, or (2) as a rsult of those high risk conditions, the pregnancy may have to be terminated before term, potentially exposing the fetus to the risks of prematurity. Clinicians who fail to recognize a high-risk condition that was present at the start of the pregnancy, or that developed during the pregnancy, may be negligent, if that condition ultimately precipitates a sequence of events that causes the baby to suffer a permanent brain injury. Some examples of the high risk conditions that need to be timely diagnosed and properly managed, include:
Hypertension and preeclampsia
Premature Rupture of Membranes,
Post-Dated or Post-Term Pregnancy,
Fetal Growth Restriction,
Meconium in the Amniotic Fluid,
Non-Reassuring or Ominous Fetal Heart Rate, and
Decreased Fetal Movement.
Preterm delivery occurs in approximately 10% of all births in the United States. Preterm labor and preterm premature rupture of the membranes often precede a preterm birth. There may also be other maternal complications, such as preeclampsia, infection or asphyxia, that require expedited delivery. Regardless of the condition resulting in a preterm delivery, when such risks are present, the medical record should reflect that the physicians and nurses accurately determined the gestational age, monitored the fetus for signs of compromise, and implemented an appropriate management plan. Clinicians have access to several antepartum tests that have the ability to alert them to potential problems that may require intervention.
Medical centers throughout the United States routinely report mortality (survival) and morbidity (survival with complications) statistics for preterm infants born before 37 completed weeks, and for low birth weight infants who weigh less than 2,500 grams. Infants who weigh between 501 to 1500 grams at birth fall within a special category, known as extremely low birth weight, or very low birth weight ("VLBW"), and many medical centers routinely analyze the changing patterns of mortality and morbidity within this group of infants.
The gestational age and birth weight of a preterm infant have significant implications for the expected outcome. Currently, medical centers are reporting survival rates of 50% or higher for infants born between 24-26 weeks of gestation. Serious complications are uncommon with infants delivered after 32-36 weeks of gestation, particularly those with adequate lung maturity.
This web site is not intended as legal advice on cerebral palsy, and is not a substitute for obtaining guidance from your own legal counsel about cerebral palsy litigation. It provides general educational information about the standards of care and causation issues that can arise in obstetrical malpractice and cerebral palsy litigation. Readers of the articles contained within this web site should not act upon the cerebral palsy information without first consulting with a lawyer who is experienced in evaluating and litigating cerebral palsy and obstetrical malpractice cases. Mr. Apfel is admitted to practice law in Maryland and the District of Columbia. When Mr. Apfel is asked to participate in cerebral palsy
litigation filed in other states, he will associate with, and act as co-counsel with, an attorney licensed in that state who is familiar with the local laws and procedures.