Articles Posted in Hypoxic Ischemic Encephalopathy

Ms. Doe presented in active labor on an evening to Providence Regional Medical Center’s Pavilion for Women and Children. Ms. Doe, whose full-term baby was healthy at the time of her admission, was administered Pitocin and remained in labor throughout the night.

The next morning at around 5 a.m., significant signs of fetal distress occurred, including prolonged decelerations. Nurses informed the on-duty obstetrician, who was in surgery with another patient. The doctor ordered an operating room be opened for Ms. Doe.

Approximately three hours later, Ms. Doe’s daughter was delivered by cesarean section; the procedure was performed by a different obstetrician. The baby was diagnosed as having hypoxic-ischemic brain damage and — tragically — died just nine days later. The baby was survived by Ms. Doe, the baby’s mother, and her husband.
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D.W. was born at 25 weeks gestation at Jamaica Hospital Medical Center. The baby was diagnosed as having suffered hypoxic-ischemic brain damage resulting in spastic quadriplegia.

D.W. is now in the 6th grade. He attends special education classes and will never be able to live independently as a result of his brain injury.

A lawsuit was filed against the hospital and two doctors who provided care during D.W.’s delivery, alleging that they chose not to timely deliver D.W. by way of a cesarean section; the suit also alleged lack of informed consent and negligent post-delivery care. This included a failure to offer cranium cooling.
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At the end of her pregnancy, Ms. Doe experienced bleeding and pain. She went to the triage unit of Grove Hospital where she was seen by a midwife and first-year resident.

Ms. Doe was attached to a fetal monitor system, which showed decreased variability and some deceleration.

Although allegedly called, Ms. Doe’s treating obstetrician did not initially come to the hospital. An hour later, a nurse summoned the physician who arrived at the hospital more than two hours after Ms. Doe first presented to the hospital.
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At three different obstetrics appointments during the 37th and 38th week of pregnancy, Ms. Doe’s blood pressure readings showed hypertension. When she returned for another appointment toward the end of her 38th week, she had severe hypertension and decreased fetal movement.

Ms. Doe was sent to a hospital where the fetal heart monitor showed the fetal heart rate of 140 beats per minute, minimal to absent variability, and late decelerations.

The attending obstetrician ordered diagnostic testing and then attended to another patient. By the time Ms. Doe underwent a Cesarean section about two hours later, the fetal heart rate had dropped to zero.
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Ms. Doe was pregnant with twins; they shared a placenta but had their own amniotic sacs. During her pregnancy, one of the twins, Twin B, had an abnormal velamentous cord insertion and exhibited persistent absent end-diastolic flow, which indicated underlying fetal vascular stress. Velamentous cord insertion is a complication of pregnancy in which the umbilical cord is inserted in the fetal membranes. In a normal pregnancy, the umbilical cord inserts into the middle of the placenta and is surrounded by the amniotic sac.

At 24 weeks, a Doppler ultrasound revealed reverse end-diastolic flow (REDF) in Twin B’s umbilical artery. Reversal of the umbilical artery end-diastolic flow or velocity can be an ominous sign when detected after 16 weeks of pregnancy. In extreme situations, such as severe intrauterine growth restriction, the arterial blood flow can reverse directions at the end of diastole. This is referred to as a reversed end-diastolic flow.

When this condition was recognized, Ms. Doe’s treating maternal-fetal medicine specialist did not hospitalize her but continued seeing her every week until 27 weeks gestation. Two weeks later, Twin B died.
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Ms. Doe, who had a history of preeclampsia, was admitted to New York-Presbyterian Hospital to deliver her baby. She was administered Pitocin but was discontinued on order by one obstetrician before another doctor restarted it.

Despite all of this, Ms. Doe’s labor failed to progress, and the fetal monitor showed persistent variable decelerations.

Ms. Doe’s baby, a son, was subsequently born in a depressed condition, with Apgar scores of 0 at one minute and 1 at five minutes.
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Anna Scott was admitted to Jefferson Healthcare to deliver her first child. She was at first attached to a fetal heart monitor, which showed that her baby was healthy. She was then taken off the monitor for a six-hour period until her treating physician performed an artificial rupture of the membranes, after which Scott was then reattached to the fetal heart monitor.

The fetal heart monitor revealed that Scott’s baby had developed a worrisome heart rate pattern of repetitive variable decelerations with intermittent minimal variability.

Several hours later, Scott began to push. Her daughter, Lana, was born almost four hours later in a depressed condition with the umbilical cord wrapped tightly around her neck. Lana required 30 minutes of resuscitation. Lana’s Apgar scores were 3 at one minute and 4 at five minutes.
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This case arose from the tragic set of events involving A.F., a baby born with severe respiratory problems who developed permanent brain damage. A.F.’s mother, Kayla Butts, brought this lawsuit claiming that A.F.’s brain damage was caused by the medical malpractice of Dr. Sarah Hardy. It was alleged that Dr. Hardy should have transferred Baby A.F. from the hospital where A.F. was born to a hospital with a neonatal intensive care unit that could have provided the care A.F. needed in the hours after her birth.

After a bench trial, the district court agreed and entered judgment in favor of Kayla Butts for over $7 million in damages. On appeal, the U.S. Court of Appeals considered whether she presented sufficient evidence to establish that Dr. Hardy violated the applicable standard of care.

Because the district court’s finding on that issue was clearly erroneous, the court of appeals reversed the district court’s order and vacated the judgment against Dr. Hardy.
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The use of fetoscopy was first developed in the 1990s. The process involves ultrasound-guided placement of a stethoscope – a small, fiber optic instrument – in the uterus to see the fetus and the placenta.

Fetoscopy as a surgical procedure can treat various fetal conditions including congenital diaphragmatic hernia and bladder outlet obstruction. Its most common use is the treatment of a rare condition, Twin-Twin Transfusion Syndrome (TTTS).

The condition of TTTS occurs when identical twins share a placenta with blood vessel connections that cause blood to flow unevenly between the two fetuses. According to the article, “Caught on Camera” by attorney Jeffrey B. Killino, one of the fetuses develops a small amniotic sac while the other sac becomes too large. Laser fetoscopy allows the laser to break up and collapse these blood vessel connections. Reportedly, if the condition is not treated, both of the fetuses can die. TTTS occurs in approximately 1 in 2,500 pregnancies. It is expected that there will be a rise in TTTS occurrences because of the increase in fertility-assisted pregnancies.
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More than a few studies have been conclusive showing that infants with hypoxic-ischemic encephalopathy have benefited when cooled to a temperature of 30 degrees Centigrade in a median time of 58 minutes. The cooling of newborns inspired oxygen requirements in a test involving six infants diagnosed with HIE.

Five of those infants required inotropic support during the cooling procedure. The cooling would be progressively reduced after 1-2 days. Inotropic support is the intensive care of newborns to stabilize circulation and to optimize oxygen supply.

Over the years, HIE has been recognized much more frequently. The onset of cases of HIE are caused by stroke, compressive forces or changes in oxygen circulating through the fetus before and immediately after delivery.
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