Articles Posted in Hypoxic Ischemic Encephalopathy

The United States will pay $5 million in a settlement to resolve a medical malpractice lawsuit alleging that physicians at a Florida naval hospital chose not to order a cesarean section despite signs and symptoms of fetal distress. As it turned out, the fetal distress caused the baby’s permanent brain damage.

Jenifer and Sean Mochocki, a U.S. Air Force officer, reached a settlement with the federal government in this Federal Tort Claims Act case and asked the federal district court judge to approve the settlement and the medical malpractice lawsuit. The suit alleged that three Naval Hospital Jacksonville physicians chose not to order a cesarean section procedure in the face of adverse fetal heart tracing, which resulted in the Mochocki baby’s hypoxic ischemic encephalopathy (HIE), which is a permanent brain injury related to oxygen deprivation.

The settlement is partially structured in that the Mochocki family will receive $1,590,000 and approximately $3 million will be used to purchase an annuity that will allow for monthly payments of approximately $7,600 for the baby’s life. An additional payment of $4,500 will be made per month when the child reaches the age of 18 until the end of life.
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Baby Doe, two months old, underwent an MRI after being taken to a hospital by ambulance. The attending anesthesiologist, Dr. Roe, ordered Propofol to prevent Baby Doe from moving excessively during the test.

While undergoing the MRI, Baby Doe’s oxygen saturation level dropped below 90. The baby suffered respiratory arrest resulting in cardiac arrest. Baby Doe experienced hypoxic-ischemic brain damage. Baby Doe — now 9 years old — is unable to take care of himself or speak.

Following this tragic brain injury, the Doe family sued Dr. Roe and his practice alleging that the anesthesiologist chose not to properly monitor Baby Doe during the MRI. The lawsuit also claimed that an attending technician failed to notify Dr. Roe when he noticed Baby Doe’s decreased oxygen saturation. The court had dismissed the radiology technician as a party defendant on that defendant’s motion. The Doe family is appealing that ruling. Continue reading

At the moment of birth, the most objective method of assessing a newborn’s metabolic condition is by analyzing umbilical cord blood gas. To be specific, arterial cord pH and base deficit can determine perinatal hypoxia and be an insight into causes of fetal distress.

Umbilical cord blood gases are most likely interpreted in situations of high risk pregnancies when there are abnormal fetal heart rate patterns, when there is an intrapartum fever, emergent C-section for a fetal compromised, low Apgar scores (less than 3) or when there are multiple fetal births.

There are three most common causes of neonates hypoxia or asphyxia, which are when the mother is oxygen compromised, when there is preeclampsia, chronic hypertension, hypotension, hypovolemia or cyanotic heart disease. Another type of condition that causes hypoxia or asphyxia is when the oxygen flow from the placenta to the fetus is obstructed or impaired. This could be caused by a placental abruption, a cord prolapse, or repetitive cord blockage.
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When an infant is tragically injured during childbirth by the negligence of an obstetrician, nurse wife or nurse, the defense, with few exceptions, relies on medical publications. Most of these publications come from the American College of Obstetricians and Gynecologists (ACOG). On the other hand, a plaintiff’s neuroradiology expert would be called to testify about the baby’s time of injury. ACOG has taken most birth trauma injury cases as having occurred in the prenatal stages of childbirth. In other words, during labor and delivery the HIE injury (hypoxic ischemic encephalopathy), which is the basis for the lawsuit, didn’t occur during labor and delivery, but instead occurred as a matter of course during the time prenatally. That’s the standard defense.

ACOG published in January 2003 a document that created strict criteria for establishing the existence of intrapartum HIE. Applying this stringent criteria, ACOG defenders argued that the injury to the baby occurred not during labor and delivery but prenatally. The claim that the baby was asphyxiated intrapartum, that is during labor and delivery, could not have happened because the strict criteria were not met.

The published paper by ACOG took the position that 4-10% of moderate to severe neonatal encephalopathy occurred as a result of hypoxia in the intrapartum period.

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Stacy Maxberry attempted a vaginal birth after a Cesarean section birth. This is often referred to as “V-back.” During the delivery, the fetal monitor showed repetitive decelerations, a dangerous sign for the unborn child. The obstetrician in charge of the birth was Dr. Matthew Whitted, who was contacted about the repetitive decelerations showing on the fetal monitor. However, Dr. Whitted did not come to the hospital to look at the fetal monitoring strips. Maxberry was told to continue pushing.

When the fetal heart rate patterns worsened, Dr. Whitted was called again. This time he ordered a Cesarean section, which was done 30 minutes later. Stacy Maxberry’s son was stillborn.

She sued Dr. Whitted claiming that he chose not to call for a timely Cesarean section after the first phone call and chose not to evaluate the fetal monitoring strips more closely. In the hour between the first and second telephone call to Dr. Whitted, Maxberry argued that her unborn baby suffered a fatal hypoxic event. The jury agreed and entered its verdict in favor of Stacy Maxberry for the wrongful death of her unborn child at $1.5 million.

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Alice Sodjago was in labor when she was admitted to a hospital. The nurse who treated her performed a vaginal exam and noted the presence of heavy meconium. The fetal monitor revealed fetal distress. The nurse contacted a midwife who did not call the on-call obstetrician. About 20 minutes later, the midwife arrived at the hospital and called the obstetrician. Sodjago’s daughter was delivered by Caesarean section almost 40 minutes later.
As a result of oxygen deprivation, the baby, now 8 years old, suffers from cognitive impairment and cortical blindness.

Sodjago and her husband, individually and on behalf of their 8-year-old daughter, filed a lawsuit against the hospital and the midwife claiming that they chose not to perform a timely emergency Caesarean section delivery, which would have saved the baby and prevented the devastating brain damage caused by the delay in delivery.

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H.D. was admitted to a hospital in labor. The nurses and midwife observed H.D. throughout the night without any notable changes. However, early the next morning, the fetal monitor showed non-reassuring signs of the unborn child. No one consulted an obstetrician or warned a doctor about the non-reassuring signs.

About six hours later, H.D. delivered her son; he was born with the umbilical cord wrapped around his neck three times. The hospital’s resuscitation team was attending to another patient, which resulted in an 8-minute delay in having the child intubated.

As a consequence, the baby suffered severe brain damage. He is now 6 years old and has cerebral palsy, developmental delays and a seizure disorder.

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In 2008 a study was published that focused on uncomplicated pregnancies. The question was whether to induce labor in women whose gestation had reached 41 to 42 weeks. It was revealed that inducing labor in women who have reached 41 weeks of pregnancy and who were otherwise low-risk showed the condition of the baby at birth to be favorable. The goal of obstetricians was to ensure the successful delivery of the baby before 42 weeks of gestation — for the benefit of the baby and mother.

The study suggested that there was an improvement in prenatal outcomes as a result of a more proactive post-term (more than 39 weeks) labor induction practice.

This guideline has shown that there was a significant reduction in the number of stillborn infants at term, 39 weeks of gestation. In addition to this conclusion, it was found or suggested that maternal deaths were also improved with proactive labor induction.

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During Ms. Doe’s 32nd week of pregnancy, she experienced contractions. Doe went to a nearby hospital where vaginal bleeding, elevated blood pressure and pre-term labor were all noted in her hospital chart. She was under observation for about 36 hours at the hospital before she was discharged to go home.

About 14 hours after discharge, Doe’s water broke. She returned to the hospital where she delivered her daughter by way of an emergency Caesarean section. The child’s Apgar scores were 1 at one minute and 4 at five minutes.

The child was diagnosed as having suffered an asphyxia and spent a number of weeks in the hospital’s intensive care unit. The baby died one year later from pneumonia and complications of severe brain damage suffered at birth.

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Kaleb Avalos-Lanteros was born with what amounted to a fractured skull. The injury caused brain damage and was first recognized while Kaleb was in the neonatal intensive care unit at Mount Sinai Medical Center in Chicago.

The cause of Kaleb’s skull fracture was not acknowledged by anyone but was alleged to have happened when Kaleb was being cared for in the NICU. No one took responsibility, so Kaleb’s parents relied on the claim of res ipsa loquitur in suing lots of defendants, which included the hospital, EPC Healthcare Staffing and another group of companies affiliated with Sodexo Inc.

The lawsuit and its complaint included claims for what the lawyers called “specific negligence” in addition to the claim of res ipsa loquitur, which literally means, in Latin, the thing speaks for itself. In other words, the law allows this theory to be applied for a claim in which the event alleged could not have happened in the absence of negligence. That presumption is rebuttable and can be defeated, but would be a question of fact to be decided by a jury as the finder of facts.

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