American College of Obstetricians and Gynecologists

In April 2013, #560, the Committee Opinion of American College of Obstetricians and Gynecologists published an abstract stating that neonatal risks of late preterm (34 0/7 – 36 6/7 weeks of gestation) an early-term (37 07/38 6/7 weeks of gestation) births are well-established. This article or opinion states that there are several maternal, fetal and placental complications in which a late-preterm or early-term delivery is warranted.

It must be noted that ACOG as an organization has long been protecting obstetricians, anesthesiologists, nurses, hospitals, midwives and other medical providers with its opinions and publications from the lawsuits arising from some of the unfortunate errors or omissions made by such medical providers in labor and delivery rooms around the country that have permanently and tragically injured newborns and too often mothers.

The timing of delivering such patients must balance a maternal and newborn risks of late-preterm and early-term delivery with the risks of further continuation of the pregnancy. All decisions regarding timing of delivery have to be individually assessed. The opinion states that amniocentesis for the determination of fetal lung maturity in well-dated pregnancies generally should not be used to guide the timing of the delivery.

There are several important principles to consider in the timing of delivery. First, the decision-making regarding timing of delivery is complex and must take into account relative maternal and newborn risks, practice environment, and patient preferences. Second, late-preterm or early-term deliveries may be warranted for either maternal or newborn benefit or both.

This Committee Opinion states that amniocentesis for the determination of fetal lung maturity in well-dated pregnancies generally should not be used to guide the timing of delivery. The reasons given for this are multiple and interrelated. First, if there is a clear indication for a late-preterm or early-term delivery for even maternal or newborn benefit then delivery should occur regardless of such maturity testing. Conversely, if delivery could be safely delayed in the context of an immature lung profile, then no clear indication for a late-preterm or early-term delivery exists. Second, mature amniotic fluid indices are not necessarily reflective of maturity in fetal organ systems other than the lungs.

This abstract is nothing new from ACOG. Obviously, the delay in delivering a newborn in fetal distress is fraught with risk of serious injury or death to the fetus. The risk of neurologic injury, permanent debilitating brain injury is high when fetal monitoring strips show a pattern that indicates the lack of blood flow or limited blood flow to the fetus.

Neuroimaging, done at the appropriate time, can rule out antenatal causes, proving newborn neurologic injury occurred at or near the time of birth. Neuro-imaging reveals patterns of injury in the involved areas of the brain – vital clues to the mechanism of injury.

Whether the newborn was a late-preterm or an early-term fetus, it could be challenging to prove the cause of the newborn’s neurologic injury in birth trauma litigation.

Determining causation begins with the newborn’s brain. The areas of the brain affected, the pattern of brain injury and the evolution of injury all provide important information about the mechanism of the injury and the timing of the injury. Early neuroimaging can show and distinguish between chronic injury and acute injury, thereby establishing a window for when exactly the injury took place. Once that window has been defined, the timing of injury can be further refined through obstetrical and neonatal clinical data and the analysis of experts.

If you or a loved one has suffered a maternal-birth injury, birth trauma injury, birth brain injury as a result of medical negligence, obstetrics negligence, labor and delivery negligence or hospital negligence, please call us for an immediate free consultation. Robert Kreisman of Kreisman Law Offices has been handling Chicago and Illinois birth injury and medical malpractice cases for more than 40 years.

With our years of experience in trying and settling birth trauma injury medical malpractice cases, Kreisman Law Offices provides the best possible services to our clients. Our service is unmatched. Please call us 24 hours a day at 312.346.0045 or toll free 800.583.8002 for a free and immediate consultation or complete a contact form online. There is no charge for a consultation that will include an evaluation of your case.

Robert D. Kreisman has been an active member of the Illinois and Missouri bars since 1976.