One of the most devastating injuries — to the individual child and to families of those physically afflicted — involve a baby deprived of oxygen at birth, causing permanent brain damage or death. In many instances, these injuries can be prevented with reasonable medical care, and therefore are actionable cases of medical malpractice.
Neonatal asphyxia is caused by a lack of oxygen during labor or delivery. Although fetal oxygen deprivation may occur at any point during gestation, childbirth is a period during which oxygen deprivation may occur due to unanticipated difficulties during labor and delivery.
The condition of low oxygenation during this time period is known as perinatal asphyxia. Because oxygen deprivation of only a few minutes can result in life-long disability for the child, it is important for an obstetrician to recognize a patient who is at risk for complications during delivery. These risks are often identified at the time of a prenatal visit. If there are risks that are significant, which may include an infant in a breech position at a late state of gestation, or placenta previa, a low-lying placenta, a Caesarean section can be planned to avert a crisis.
Fetal Oxygen and the Maternal Blood Supply
Oxygen is supplied through the hemoglobin molecule in red blood cells. Because the fetus receives oxygenated blood from the mother, through the placenta and umbilical cord, any drop in the mother’s blood pressure at any time during the pregnancy is potentially a cause of fetal asphyxia. The mother’s blood pressure may drop as a result of any of the following reasons: severe infection, dehydration, or traumatic injury with subsequent loss of blood volume.
Unfortunately, gestational problems are not usually just the result of preventable circumstances, but if a mother seeks treatment, the fetal asphyxia can be corrected as the mother’s condition is treated. The birth may still result in developmental disability, whether physical or intellectual. These cases are unfortunate, but can potentially occur in any mother during the gestational period.
Normal and Abnormal Variations in Blood Pressure During Labor
Fetal asphyxia can occur in a variety of situations during labor and delivery. Contractions of the uterus cause subsequent interruptions in blood flow to the placenta, which is normal. However, any occlusion, or blockage, of the umbilical cord will interrupt circulation to the fetus, causing a decrease in fetal oxygen content, and, potentially, an increase in the content of carbon dioxide or carbonic acid, which are the waste products of the metabolism of the fetus. Oxygen supply to the fetus is decreased, and an excess of acid, which is normally kept in a steady state known as homeostasis, can occur.
There are some mechanisms that may allow the fetus to accommodate momentary interruptions in oxygenation, but the fact remains that these mechanisms are not designed to adapt to any prolonged period of oxygen deprivation.
Emergent Situations and Complications
Some situations, which must be handled emergently to prevent compromise of the fetal oxygen supply during labor and delivery, include:
- Fetal distress during prolonged and ineffective labor,
- Fetal distress as a result of premature rupture of the amniotic membrane, due to development of a severe infection of the amniotic fluid. Umbilical cord prolapse, which refers to the umbilical cord presenting before the neonate, resulting in compression. A “nuchal cord” refers to the umbilical cord when it wraps itself around the neck of the infant. A nuchal cord must be immediately manipulated to ensure the child continues to receive adequate oxygen.
- Shoulder dystocia occurs as the shoulder fails to deliver after the head and becomes lodged on the mother’s pubic bone. Compression and occlusion of the umbilical cord may result from this complication of delivery. Although this condition occurs without warning during the moments of delivery, the obstetrician must maneuver the infant rapidly and correctly to effect delivery.
- Abruption of the placenta, or separation of the placenta from the uterine wall prior to delivery. The resultant hemorrhage results in loss of an adequate blood supply to the fetus. In this case, an emergency caesarean delivery may save the life of mother and child, as placental abruption may cause an exsanguinating, life-threatening hemorrhage. However, even with emergent intervention, the mortality rate remains high from placental abruption.
Fetal monitoring during these times demonstrates patterns of abnormal fetal cardiac activity as a result of inadequate oxygenation, and must be addressed by the obstetrician with Caesarean delivery, if vaginal delivery is unlikely to result in a good outcome. Although there are drugs that can induce vaginal delivery, they take time to work, and fetal distress is a definite indication for immediate delivery.
Results of Fetal Oxygen Deprivation
Oxygen deprivation can result in cerebral palsy, a disorder that is characterized by abnormalities of movement and posture. The developing brain is especially sensitive to lack of oxygen, and resultant permanent neurologic damage may be devastating. Consequences of oxygen deprivation may range from mild developmental or cognitive delay to severe problems that require institutionalization or lifelong care. There is an association between infants who suffer from hypoxia and a higher risk of Sudden Infant Death Syndrome.
Should your child have a significant birth injury, you may face a lifelong burden of medical bills, and you may have questions still about the cause of a poor outcome. If you feel you have questions that could be answered by our experienced staff of attorneys, don’t hesitate to call us at 312-527-4500 for a free consultation.