During pregnancy, the fetal brain needs adequate supplies of oxygen and glucose, among other things, to develop normally. Oxygen and glucose originate in the maternal blood, where they are are transported to the placenta, then through the
umbilical cord, to the fetal circulatory system, and, finally, to the fetal brain. After delivery, the newborn lung replaces the placenta as the primary organ responsible for oxygenating the blood circulating within the newborn infant.
Certain maternal, fetal, or neonatal conditions can interfere with normal blood flow to the fetal or newborn brain ("schemia"), or reduce the oxygen content of the blood perfusing the brain tissue ("hypoxemia"). This can happen before the onset of labor (the antepartum period), during labor and delivery (the intrapartum period), or after birth (the immediate neonatal period). Unfortunately, neonatal intensive care units across the United States continue to admit and treat infants with hypoxic or ischemic complications that eventually lead to permanent neurological injury or other handicapping conditions, such as cerebral palsy.
Sometimes, the clinical condition of the newborn immediately after birth will alert the physicians and parents to the fact that the baby suffered a brain injury. In many of those cases, the primary diagnosis is ("perinatal asphyxia"), or ("birth asphyxia"), or ("hypoxic ischemic encephalopathy"), (referred to by many physicians as HIE). In other cases, the parents may not realize that their child suffered a brain injury until the child fails to achieve developmental
milestones during the first year of life.
Regardless of when the parents find out about their child's condition, when they ask physicians for an explanation as to why their child suffered an irreversible brain injury, they are routinely told by their physicians that the outcome was unavoidable. Yet, a review of the clinical records may disclose a history of one or more maternal, fetal, or newborn complications that would have been capable of
initiating a sequence of events leading to the brain damage: some of these complications or risk factors are preterm labor, premature rupture of the membranes, hypertension, diabetes, oligohydramnios, trauma, maternal infection, neonatal sepsis, abnormal blood gas studies, nonreassuring fetal heart rate patterns, breech presentation, intrauterine growth retardation, or placental insufficiency due to postdated pregnancy.
Thus, parents may suspect that all of the facts and circumstances that led to the brain damage are not being fully disclosed. They may decide to consult with an attorney, whom they may retain to conduct an independent evaluation of the medical records, with the help of qualified experts, to determine the cause and timing of their child's brain injury, and whether the adverse outcome could have
been prevented with proper obstetric or neonatal care or earlier delivery.
This web site provides information concerning a wide range of medical topics, to provide parents with an overview of the many issues that can arise in the pursuit of a birth trauma case. The topics include: placental pathology, electronic fetal monitoring, antepartum fetal testing, perinatal infection, the assessment and management of newborn complications, blood gas testing and pediatric neuroimaging. At a minimum, parents looking for a possible explanation for their child ís brain injury will learn about the mechanism of birth asphyxia and how asphyxia may contribute to cerebral palsy.
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.