Albany Birth Injury Lawyers

Extracranial injuries

Extracranial injuries or injuries existing on the outside surface of the skull, occur during delivery and are caused by excessive fluid accumulation or bleeding into various locations above and below the periosteum, a dense fibrous membrane covering the surface of the skull. Some of these injuries resolve over time while others can be severe and even deadly. These injuries can result in significant deformities of the skull.

Severe hemorrhages can occur when the veins between the scalp and the narrow passages separating the skull and the brain are severed from traction during delivery. This type of injury poses a high risk of massive blood loss and death. Early recognition of this injury is crucial for the infant to survive.

Intracranial injuries

Intracranial injuries present as hemorrhages or hematomas within the skull. While rare, the risk of this injury increases with the use of obstetrical instrumentation during delivery. Infants suffering from these types of injuries generally have symptoms or findings within the first 24 to 48 hours and can include respiratory depression, apnea, seizures, changes in levels of vital signs and consciousness, and/or a bulging of the “soft spot” on a newborn’s skull. Depending on the location of this injury, some cases can be managed by conventional therapy while others require surgical intervention.

Shoulder Dystocia

Shoulder dystocia, a term used when additional obstetric maneuvers of the fetal shoulders are required to effect delivery, is an obstetrical emergency and can cause permanent birth injury and even fetal death. Because shoulder dystocia is not easily anticipated, all obstetricians must be prepared for the occurrence and promptly take steps to minimize the risk to mother and newborn.

The risk that shoulder dystocia will occur during delivery is increased if:

• The mother has previously delivered a large infant (over 8 pounds and 13 ounces) or shoulder dystocia occurred in prior deliveries
• The mother has diabetes
• The fetus is more than 41 weeks old
• The estimated fetal weight is greater than 8 pounds and 13 ounces

All patients who have these risk factors should be scanned with an ultrasound during the third trimester to better estimate fetal weight. A caesarean section is generally recommended if:

• The mother is diabetic and the estimated fetal weight is more than 8 pounds and 13 ounces, or
• The mother is not diabetic and the estimated fetal weight at delivery is greater than 9 pounds and 15 ounces

Brachial plexus

Brachial plexus injury and fracture of the clavicle are the most common types of injuries associated with shoulder dystocia. Other injuries that can occur include hypoxic brain injury, permanent brachial plexus palsy, maternal hemorrhage, fracture of the humerus, and infant death.

Brachial plexus injuries can occur when there is an impediment to delivery, such as shoulder dystocia or fetal positioning, causing an obstetrician to inadvertently use excessive force when extracting the fetal head during delivery.

Injuries to the brachial plexus, which is a system of nerve fibers that begin near the neck and shoulder, stem from the trauma these nerve fibers receive. These nerves are responsible for controlling the hand, wrist, elbow, and shoulder. Some cases of brachial plexus injury involve combinations of the following:

• Nerve damage to the arm causing full to partial paralysis;
• The nerves at the 5th or 6th cervical vertebrae are damaged, causing paralysis of the deltoid, supraspinatus, infraspinatus, biceps and brachio-radialis muscles (Erb’s Palsy).
• Injury to the phrenic nerve, which can cause a paralyzed diaphragm resulting in breathing difficulty and frequent lung infections;
• Damage to certain nerves that travel from the brain to the eyes and face causing drooping eyelids, decreased pupil size, and decreased sweating on the affected side of the face (Horner’s Syndrome); and
• Isolated paralysis of the hand(s) combined with Horner’s Syndrome (Klumpke’s Syndrome).

Cerebral Palsy

Cerebral palsy results when the amount of oxygen reaching the infant’s brain is insufficient or suffering from “hypoxia.” When this occurs, brain cells will begin to die. If enough brain cells die, permanent, irreversible brain damage (“hypoxic ischemic encephalopathy” (HIE)) occurs. Because of the danger of HIE, doctors generally monitor the well-being of the baby throughout the birth process.

An electronic fetal monitor (EFM) measures the fetal heart rate. If the heart rate changes in response to the stresses of labor and delivery, the baby may be suffering a lack of oxygen (hypoxia and ischemia). This is called fetal distress.

If the fetal heart monitor shows the baby is in distress, immediate action should be taken to prevent brain damage. Doctors and midwives may:

• Provide the mother with additional oxygen through an oxygen mask
• Reposition the mother to increase the efficiency of the mother’s circulatory system
• Perform a vaginal examination to determine if the umbilical cord is prolapsed (in the wrong place)

If these simple solutions do not help and the fetus continues to show distress, parents should be told of the risk to the baby and allowed to decide whether to continue with labor or immediately deliver the baby through an emergency c-section.

As a general rule, a review of the medical chart of an infant who suffered cerebral palsy as the result of anoxic brain damage will show that the child had:

• Profound metabolic or mixed acidemia in the umbilical cord arterial blood, exhibited by a pH of less than 7.00; and
• APGAR scores between 0-3 for more than 5 minutes after birth; and
• Neonatal seizures, hypotonia or coma, and
• Dysfunction in any or all of the child’s cardiovascular, gastrointestinal, hematologic, pulmonary or renal systems.

Medical negligence may have occurred if the healthcare provider:

• Failed to monitor the condition of the mother and fetus during labor and delivery
• Failed to review the test strip on the fetal heart monitor
• Failed to take prompt action when fetal distress was apparent
• Failed to inform parents of the risk and to conduct an emergency c-section