Articles Posted in Birth Injuries

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According to the American College of Obstetricians and Gynecologists, all Central New York OBGYNs should closely review the nature of their practice and consider whether their patient load, hours worked and other time commitments are causing fatigue-related birth injuries.

A recent study suggests that most OBGYNs practicing in Upstate New York hospitals do not sleep enough. The most sleep deprived include residents and specialists on call, such as neonatologists. Without at least five hours of sleep, a doctor’s speech, numerical skills, memory and concentration decline. Missing faculties can leading to medical mistakes. Doctors awake more than 19 hours performed worse on tests than individuals with a blood alcohol content of 0.05. The legal limit for drunk driving in most U.S. states is 0.08.

During a labor and delivery, minutes and even seconds matter to a baby that may not be receiving appropriate blood flow and, in turn, may be suffering from brain damage due to a lack of oxygen. After just a few minutes of low oxygen levels, a fetus may develop cerebral palsy. Because delay caused by doctor fatigue and sleep deprivation could result in permanent injury to a baby, ACOG recommends that OBGYNS follow good sleep habits, sleep immediately after long shifts, make arrangements for a backup, nap, and avoid working between 2 a.m. and 9 a.m.
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According to the American College of Gynecologists (“ACOG”), with members including Binghamton New York obstetricians and Binghamton New York gynecologists, women should not deliver at home because a labor and delivery complication during a Central New York home birth could result in birth injury or death.

ACOG explains that labor and delivery complications can arise without warning, even in low-risk patients. Appropriate treatment for a complication, such as a shoulder dystocia or an umbilical cord wrapped around a baby’s neck, must come from an OBGYN or skilled birth center capable of determining whether a cesarean section is necessary to prevent Erb’s palsy, cerebral palsy or other birth injury. In high risk cases, such as vaginal birth after cesarean (“VBAC”) deliveries, a complication such as a uterine rupture could also lead to the death of a pregnant mother if hemorrhaging is not treated. ACOG reports that “the safest setting for labor, delivery, and the immediate postpartum period is in the hospital, or a birthing center within a hospital complex.”

ACOG also advocates against deliveries managed by midwives who are not certified by the American College of Nurse-Midwives or American Midwifery Certification Board.
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Last month, Bottar Law, PLLC partners Edward S. Leone, Esq., and Anthony S. Bottar, Esq., secured $3,250,000.00 in compensation from a group of Syracuse medical defendants. The Syracuse birth injury lawsuit sounded in Syracuse OBGYN malpractice and Syracuse hospital negligence, and alleged that the defendants collectively failed to identify signs of fetal distress, failed to respond to labor and delivery complications, and failed to perform a cesarean section before the unborn baby’s brain was permanently damaged by prolonged hypoxia. Shortly after birth, the infant plaintiff was diagnosed with spastic quadriplegic cerebral palsy, further complicated by seizures, as well as hearing and vision loss.

Plaintiff’s claims included allegations that the defendants: failed to appreciate a lack of beat-to-beat variability, failed to note the absence of accelerations, failed to respond to a hypertonic contraction pattern, failed to respond to minimal variability, failed to appreciate and respond to thick meconium after rupture of membranes, prescribed Pitocin in the face of a non-reassuring fetal heat rate and uteroplacental insufficiency, and wholly failed to continuously monitor for and respond to prolonged decelerations.

Plaintiff’s settlement proceeds will be used to fund a trust (for future medical care), with a lifetime value of nearly $10,000,000.00.

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Every time a baby is born in an upstate New York hospital, such as Samaritan Medical Center in Watertown, New York, Faxton-St. Luke’s Healthcare in Utica, New York, Crouse Hospital in Syracuse, New York, St. Joseph’s Hospital Health Center in Syracuse, New York, Oswego Hospital in Oswego, New York, or Auburn Hospital in Auburn, New York, the baby’s birth weight is recorded. That data is made available to researchers who study trends in newborn birth weights.

A recent Harvard study reports that newborn birth weights are down in the United States by about 1.8 ounces. Average birth weights now hover around 7 pounds 6 ounces. The decline in baby weight is a positive development as larger babies are at greater risk for birth injuries and birth trauma, such as a shoulder dystocia because a baby’s body is too big for the birth canal or where a baby sustains brain damage from a lack of oxygen that leads to cerebral palsy. Macrosomic babies, including large babies because of a failure to diagnose gestational diabetes, are also at greater risk for diabetes and obesity later in life.
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Oligohydramnios near term may be an indication for delivery, either by induction or c-section.

During pregnancy, the baby floats inside the placenta in a liquid known as amniotic fluid. The fluid is swallowed by the fetus. It is then excreted by urination. The level of amniotic fluid within the placenta may be a marked for fetal distress. The failure to diagnose low amniotic fluid, or the failure to diagnose too much amniotic fluid, can cause a birth injury due to medical malpractice.

Oligohydramnios is a condition where there is not enough amniotic fluid. It is usually marked by an AFI of less than 6. Hydramnios and Polyhadramnios is a condition where there is too much amniotic fluid. It is usually marked by an AFI of greater than 18. Generally, if there is an appropriate amount of amniotic fluid, a doctor may assume that the baby’s kidneys are functioning normally, which usually means that the heart is functioning normally, and on down the line.
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A birth injury is damage to a baby during labor and delivery, also known as the birth process. Generally, birth injuries are due to a lack of blood flow (ischemia), a lack of oxygen (hypoxia), acidosis, internal forces (pressure applied by the birth canal), and/or external forces (pressure applied by a healthcare provider). Commonly, a Syracuse birth injury lawsuit is based upon a constellation of medical malpractice, including obstetrician mistakes, obstetrical group errors, and nursing negligence.

There are many risk factors for a birth injury. Risk factors for a birth injury include large-for-date infants, post-date infants, macrosomia, excessive maternal weight gain, gestational diabetes, inadequate pelvis, prolonged labor, rapid labor, and a prior complicated delivery.

Birth injuries can be mild, moderate or severe. Common examples include Erb’s palsy, Klumpke’s paralysis, cerebral palsy, cranial nerve palsy, facial palsy, hypoxic ischemic encephalopathy, periventricular leukomalacia, hematomas and fractures.
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Preeclampsia is a pregnancy complication affecting 10% of women. It is marked by high blood pressure and proteinuria (protein in the urine). Symptoms usually emerge in the 20th week of pregnancy, and include: headaches, hand and foot swelling (edema), excessive weight gain and, in extreme cases, blindness.

Preeclampsia must be timely diagnosed, because if left undiagnosed it can develop into eclampsia. Eclampsia can cause seizures, brain damage and death (for mother and child). Worldwide, preeclampsia is responsible for 500,000 infant deaths and 76,000 maternal deaths every year.

According to a recent study conducted by scientists at the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institute of Health, there may be a connection between maternal plasma concentrations and the risk for developing preeclampsia. The relationship between maternal plasma and preeclampsia should lead to a decrease in medical malpractice due to the late diagnosis of preeclampsia, as doctors will be able to screen for a patient’s predisposition to develop the dangerous condition.
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A baby girl diagnosed with cerebral palsy shortly after birth recently enjoyed the fruits of cord blood research. While medical malpractice and birth injury or birth trauma (e.g., asphyxia, hypoxic ischemic encephalopathy, and ischemia) account for many cases of cerebral palsy, her disability was not due to medical malpractice. Rather, her brain damage was the result of an utero stroke.

Shortly after the baby’s first birthday, the family turned to stem cells banked during birth for a solution to their daughter’s permanent mental and physical disabilities, including an inability to hold her bottle, talk and walk. After a fifteen minute re-infusion of her stem cells, the baby girl began to improve. Within four days. her rigid right side began to loosen and her speech improved. Then she stopped dragging her foot and began to use her right hand. She now lives a normal life.
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A study published recently by several prominent pediatricians and neonatologists reports a connection between a baby born with low oxygen levels and a low IQ. According to the study, children resuscitated after birth were 65% more likely to have an IQ below 80 at age eight.

Previously, doctors believed that brain damage occurred only when fetal hypoxia lasted long enough to cause encephalopathy. However, the study established that mild hypoxic events can cause permanent harm to a child’s brain – a harm that cannot be identified for many years. The study further devalues APGAR scores, which have come under fire over the past few years. Many OBGYNS use APGAR scores to estimate a newborn’s condition even though it is wholly subjective and suffers from poorly reproducibility. The study establishes that an infant with normal APGAR scores can have brain damage.

According to Maureen Hack, M.D., and Eileen Stork, M.D., of Case Western Reserve University in Cleveland, “[a]ssessment of a perinatal hypoxic event and its prognosis needs an objective measure other than the neonatal neurological presentation alone.”

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Shoulder dystocia occurs in approximately 1% of deliveries. It occurs when, after delivery of the fetal head, a baby’s anterior shoulder becomes lodged (i.e., stuck) behind a mother’s pubic bone. In turn, the baby does not progress properly and specific maneuvers may be necessary to free the baby’s shoulders to prevent entrapment of the umbilical cord and oxygen deprivation.

Risk factors for a shoulder dystocia include a prior shoulder dystocia, diabetes, an inadequate pelvis, an abnormal pelvis, multiparity, prolonged gestations, preeclampsia, advanced maternal age, fetal macrosomia (large baby), and maternal obesity. As many as 20% of shoulder dystocias cause injury to the baby. These injuries include collar bone fractures, contusions, lacerations, birth asphyxia and damage to the brachial plexus nerves which can lead to Erb’s Palsy and Klumpke’s Paralysis.

Dr. Emily Hamilton, of Montreal has developed an algorithm that, once populated with data regarding a mother and an unborn baby, can calculate the probability of a shoulder dystocia. That algorithim is incorporated into the computer program called the CALM Shoulder Screen, which is making its way to the offices of obstetricians around the county. The program, which is web-based, is effective beginning at 37 weeks of gestation.
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