Placental abruption: Can a genetic test predict and prevent it?

Placental abruption: Can a genetic test predict and prevent it?

Childbirth is a common occurrence, and through the years, advances in medical practices and procedures have decreased the risks of injury and death to both mother and baby. While great strides in medicine have reduced pregnancy complications, there are still some instances where situations arise that increase the risk of injury or death during childbirth. Placental abruption is one complication that occurs during seemingly routine delivery situations. Breakthroughs may help put this menace on the back burner.

What is placental abruption?

Placental abruption occurs when the placenta separates from the uterus at some point during pregnancy. It can cause the baby’s oxygen and food supply to be cut off, and the mother to excessively bleed. It is a rare complication, but when it happens, the mortality rate to mother and baby is higher. If nothing else, the baby may suffer brain damage as a result of the lack of oxygen to the brain.

What role might genetics play?

In a sweeping study conducted by the University of Washington School of Public Health, scientists discovered previously undetected diversity in genes that provide vital placental support and function. It may mean that genetic markers could indicate a mother’s predisposition to suffering placental abruption during pregnancy. The study identified genetic variations for those women who had the placenta separate. Identifying women who have a predisposition to placental breaks means closer monitoring during pregnancy to detect and possibly even repair the abruption before permanent damage occurs.

Placental abruption is rare, but it can be a fatal complication during pregnancy and childbirth for both mother and baby. It may be difficult to detect, which makes long-lasting complications for the baby more likely through lack of fetal development and brain damage resulting from oxygen deprivation. Because the symptoms of placental abruption can be challenging to detect, it may go untreated until childbirth. At that point, the damage inflicted is irreversible. Advancing detection and subsequent treatment is a matter of life and death for mother and baby.

Understanding hypoxic ischemic encephalopathy

Understanding hypoxic ischemic encephalopathy

Hypoxic ischemic encephalopathy is a condition where the infant does not receive enough oxygen while in the womb. This leads to brain cells sustaining injuries, and it can happen in a variety of ways. Studies suggest that between two and nine out of every 1,000 live births will experience HIE.

It is vital for providers to recognize the symptoms of HIE well in advance so that treatment can begin right away. Occasionally, the doctor will be at fault for this condition, and in this instance, the parents may want to consider legal action.

The causes

There are several ways this condition can come about. Some of the most common explanations include:

  • Blood-clotting disorders from the mother
  • Fetal-maternal hemorrhage
  • Cord prolapse
  • Placental blood clots
  • Trauma occurring during delivery
  • Low maternal blood pressure
  • Placental insufficiency
  • Cord compression
  • Drug and alcohol abuse from the mother

There are several diagnostic tools doctors can use to determine if an infant suffers from HIE. Imaging tools are most common, such as MRI, ultrasound and EEG. The doctor can also utilize the Sarnat Scale, which takes into account the baby’s appearance after birth.

The symptoms

The most apparent symptoms will be the presence of depressed, irregular or slow breathing. Additional symptoms can include:

  • Seizures
  • Acidosis
  • Skin color appearing pale or blue
  • Low or floppy muscle tone
  • Stained meconium
  • Depressed or completely absent reflexes

The treatments

Regardless of how this condition appeared, it is paramount to begin treatment as soon as possible. When the infant suffers from delayed, depressed breathing, the doctor may recommend mechanical ventilation to aid the baby in breathing. Another treatment may involve cooling the infant’s body or brain to reverse the effects of brain hypoxia. Medications and general anesthesia are available to prevent the baby from experiencing seizures. An array of treatments exist to help the baby better control his or her blood pressure and heart function.

Birth injury: hypoxic-ischemic encephalopathy

Birth injury: hypoxic-ischemic encephalopathy

Hypoxic-ischemic encephalopathy, also known as perinatal asphyxia, is brain damage that happens when an infant does not receive sufficient oxygen and blood. This is a severe condition that can have long-lasting effects and even cause fatalities. In fact, birth asphyxia accounts for 23 percent of newborn deaths.

It is important to know the causes, symptoms, effects and treatments that are potentially relevant to HIE. Here are the basics facts you should consider if your infant received this diagnosis.

Causes

HIE can occur before, during or after birth. There are many circumstances that cause asphyxia, including these examples:

  • Medical negligence
  • Cardiac complications
  • Blood circulation problems with the placenta
  • Fetal anemia
  • Lung malformations
  • Prolonged labor
  • Infections
  • Prematurity
  • Umbilical cord accidents
  • Maternal high blood pressure

However, there are numerous other problems and events that lead to this condition. In some situations, there are no identifiable causes for newborn HIE.

Symptoms

These are some signs your baby may have HIE:

  • Poor muscle tone
  • Diminished tendon reflexes
  • Low or irregular heart rate
  • Poor feeding
  • Pale or bluish skin color
  • Irritability
  • Weak or irregular breathing
  • Poor feeding
  • Absent newborn reflexes of grasping, sucking or swallowing
  • Lethargy
  • Hypotonia
  • Seizures
  • Dilated pupils

Make sure your doctor assesses the symptoms and runs analytic procedures to diagnose the condition. Diagnostic tests may include MRI or CT scans, umbilical artery blood samples, Apgar tests and electroencephalography.

Effects

HIE can result in various medical complications. The conditions largely depend on whether the asphyxia is mild, moderate or severe. Here are some of the most common consequences:

  • Developmental delays
  • Motor skill delays
  • Cognitive problems
  • Epilepsy

The most severe cases involve infant death.

Treatment

The precise treatment varies depending on the severity of damage to the brain and the causes of the condition. Your newborn might need one or more of the following procedures or therapies:

  • Mechanical ventilation for breathing assistance
  • Medications and anesthesia to control seizures
  • Blood pressure management

Be sure to consult your doctor about the most effective treatment method.

Nuchal cord and how it may affect an infant

Nuchal cord and how it may affect an infant

Nuchal cord is a condition that occurs when the umbilical cord wraps around the neck of a fetus or newborn baby. This can result in serious brain damage to the infant because of an insufficient supply of oxygen. This is a severe condition that can have long-lasting effects and even cause fatalities. Disturbingly, this is a common pregnancy complication. According to a recent medical study, approximately 10 to 29 percent of fetuses suffer from nuchal cord.

It is important to know the causes and symptoms that are potentially relevant to nuchal cord.

Causes

Nuchal cord may develop any time during pregnancy. There are many circumstances that cause this condition, including these examples:

  • Fetus movements
  • Insufficient Wharton’s jelly
  • Carrying more than one baby
  • Excessively long umbilical cord
  • Poor structure of the cord
  • Excessive amounts of amniotic fluid

However, there are numerous other problems and events that lead to this condition. In some situations, there are no identifiable causes for nuchal cord.

Effects

Nuchal cord can result in various medical complications. The consequences largely depend on whether the doctor is able to diagnose and quickly deliver a baby who is suffering from nuchal cord and asphyxia. Here are some of the most common consequences:

  • Developmental delays
  • Cerebral palsy
  • Learning disabilities
  • Motor skill delays
  • Cognitive problems
  • Low Apgar score
  • Diminished tendon reflexes
  • Poor feeding
  • Irritability
  • Absent newborn reflexes of grasping, sucking or swallowing
  • Lethargy
  • Hypertonia
  • Seizures
  • Organ failure

The most severe cases involve infant death.

Management

If a doctor detects a nuchal cord during an ultrasound, there must be a special procedure during delivery. The doctor may need to perform one of the following actions:

  • Slip the cord off of the baby
  • Use the somersault technique
  • Cut or clamp the cord
  • Perform an emergency C-section

Failure to properly manage this condition may count as medical negligence.

Ways to prevent birth injuries

Ways to prevent birth injuries

An expectant mother would never want to have her newborn baby suffer an injury — or to be injured herself — before, during, or after delivery. While some problems result from an emergency that medical professionals could not predict, treat, or prevent, some injuries are the result of negligence or medical error.

Understanding the various ways to avoid certain birth injuries is a proactive step that all expectant mothers can take as they proceed through prenatal care and into the delivery room. While not all injuries are preventable, some risks can be reduced with appropriate knowledge and action.

Steps for preventing birth injuries

Mistakes are an all-too-common occurrence in all areas of medicine, not just in the sector of newborns and deliveries. One of the most important ways to prevent errors is to have clear, open, and honest discussions with your healthcare provider. This includes communication about any medicines you are taking or that your doctor prescribes for you during prenatal care, delivery procedures, and post-delivery hospital supervision. If doctors schedule you to have surgery, such as a C-section, or another procedure during your delivery, such as tubal ligation, make sure that you understand everything that is going to take place.

Typical birth injuries

It is important that you understand what the typical birth injuries are and how to avoid those that may be preventable. Sometimes, medical staff may fail to recognize complications during prenatal care or delivery. Also, doctors may fail to perform a C-section when it is medically necessary. Both of these cases could indicate negligence on the part of the doctors. The wrong medicine could also cause preventable complications, and improper use of medical equipment could harm you or your newborn during the delivery.

While you cannot prevent a doctor from making a neglectful error, you can take as proactive an approach as possible. The first step is ensuring that you know what is happening — and why — in all phases of your prenatal care, delivery, and postnatal period.

Birth injuries and medical negligence

Birth injuries and medical negligence

Parents expecting their first baby feel joy and anticipation and may daydream about their son’s little league trophy or their daughter’s science project award. The parents dutifully follow their obstetrician’s instructions; the mother attends maternity exercise classes, and the father learns how to coach his wife through delivery. Grandfather opens a college education savings account as a gift for the little one’s arrival.

When the ninth month arrives, the couple gently reminds their parents it’s OK not to call and check on progress several times a day.

Normal injuries to newborns

No matter how many birthing classes parents attend, internet tips they read or stories they hear about childbirth from their friends, each birth is unique. The couple anxiously hopes all will be well with mother and baby during delivery.

The physical pressure of contractions exert force on the baby to move it through the birth canal. Minor birth injuries usually heal without treatment. Doctors should know well in advance if a fetus is in danger of severe birth injuries. If the baby is too large or lying in the wrong position, a doctor can perform a Cesarean section to prevent birth injury.

Preventable disease or injury

In natal defects, it can sometimes be difficult to tell if the doctor acted negligently or whether a genetic complication no one could have detected has occurred. There are areas where the doctor is responsible for the identification and treatment of preventable problems. A few of these areas include the following:

  • Brain injuries, most commonly cerebral palsy caused by medical failure to rectify umbilical cord oxygen deprivation, carry out a necessary C-section, or treat maternal infections
  • Delivery injuries, such as broken bones or severe nerve damage, caused by a physician’s improper use of forceps, vacuum extractors or other delivery tools
  • Medication injuries, caused by a doctor prescribing medications during pregnancy known to cause high blood pressure in the baby which shuts off its oxygen or results in congenital disabilities
  • Diagnostic failures, when a doctor should have identified and treated infections, vitamin deficiencies, or fails to perform a C-section to prevent meconium aspiration and breathing difficulties occurring to the baby in long, difficult labor

Parental information rights

If a parent feels something is wrong or does not understand a procedure, he or she has the legal right to ask questions and receive prompt understandable answers. Parents should trust their instincts. If the baby appears to be in difficulty, parents should not let these issues drop. Parents are not required to accept vague assurances by medical staff that all is well. Their child’s future may be at risk. Doctors and hospitals are usually responsible when preventable birth injuries occur.

Understanding Erb’s palsy

Understanding Erb’s palsy

As a Kentucky mom-to-be, you likely can hardly wait to welcome your new son or daughter into your family. The birth of a baby always tops the list of exciting and life-changing events in any parent’s life. And the last thing you want to think about is the possibility of your baby sustaining a birth injury such as Erb’s palsy during your labor and delivery.

You obviously realize that your baby, like you, has a system of nerves throughout his or her body that allows him or her to move and feel sensation. A person’s brachial nerves run from the spinal cord to the armpits and from there down the arms. Should your baby’s brachial nerves become stretched or otherwise injured during his or her birthing process, the result could be Erb’s palsy, a weakness or even paralysis of his or her arms.

Surprisingly for such a serious birth injury, some babies “outgrow” the effects of Erb’s palsy during their first year of life. Others, however, do not. In such cases, surgical intervention is the only way to prevent or minimize permanent damage.

Risk factors

You should be aware that your baby stands a much higher likelihood of suffering from Erb’s palsy under the following conditions:

  • If (s)he weighs more than usual at the time of his or her birth
  • If you are a smaller than usual woman
  • If your OB/GYN must assist your baby’s birth with vacuum extraction
  • If your OB/GYN must assist your baby’s birth with low- or mid-level forceps
  • If your baby delivers during your second stage of labor
  • If you have one or more older children who suffer(ed) from Erb’s palsy

To treat or not to treat?

As stated, some children spontaneously recover from Erb’s palsy. Consequently, most medical professionals agree that a very young baby faces more risk from undergoing surgery than (s)he does from Erb’s palsy. Your pediatrician may therefore recommend a wait and see approach if your baby suffers from it, only putting him or her on a course of physical therapy during his or her first year of life to minimize its effects.

Should your baby be one of those who does not spontaneously recover, however, then your pediatrician likely will recommend one or more surgeries. Without surgical intervention, your child could suffer debilitating Erb’s palsy effects throughout his or her life.

Communication and action key during labor and delivery

Communication and action key during labor and delivery

A woman in labor needs monitoring and assistance from those around her. Advances in medicine have evolved to make birth a much safer event for mother and baby; however, things may still go wrong.

When the situation in the labor and delivery room goes awry, the baby may suffer an injury. The consequences of injury range from temporary bruising to long-term deficiency to death. The most common denominator in birth injuries is miscommunication between the medical team.

Failure to recognize distress

Labor puts an immense amount of pressure on mother and baby. If the mother starts to experience issues, such as irregular heartbeat or a spike in blood pressure, these could spell trouble for the baby. When the medical team misses a sign of distress, the baby may face real danger.

Unnecessary use of birth tools

Babies may get stuck in the birth canal, and if the doctor fails to remove the baby in a timely manner, oxygen deprivation may occur. Too quickly, medical teams choose to use tools to pull the baby free rather than using other less obtrusive methods. These tools, such as vacuum extractor and forceps, attach to the baby’s head, placing pressure on it. The use of these increases the chance of a head injury. The dislocation of the shoulder and fracture of the clavicle frequently occur with forcible extraction.

Waiting too long to perform a C-section

If labor is taking too long without progressing to the next stage, there is a chance the mother will need a C-section. The mother may not want a C-section or the doctors may believe labor will eventually give way to vaginal birth, so they dismiss the option of performing surgery. Unfortunately, failing to extricate the baby sooner rather than later may result in a traumatic birth injury.

The magic and wonder of birth can turn tragic if the medical team is not following warnings. Doctors and nurses cause more birth injuries by missing signs of distress, jumping the gun on birth aids and waiting too long before performing a C-section. These missteps may prove devastating to a baby and mother.

Common mistakes made in surgeries

Common mistakes made in surgeries

Surgeons have an extremely difficult job. Although they receive years of education and training, they still make mistakes, like in any other profession, often leading to medical malpractice cases.

There are many errors some patients have had to contend with. One of the most common surgical mistakes involves the surgeon performing the wrong procedure on the patient. This is typically due to a clerical error where the surgeon received the wrong paperwork. Here are some other mistakes surgeons have made over the years.

Leaving the catheter in for too long

Following surgery, many patients are reliant on a catheter. The medical team needs to know precisely when to remove this catheter, or else it can result in a urinary tract infection. Although this type of infection is relatively easy to treat, it can lead to more serious problems if the patient delays treatment. A kidney infection could soon develop, requiring another visit to the hospital.

Providing the wrong dosage of medication

After surgery, the doctor often prescribes medication, such as antibiotics or painkillers, for the patient to take. The doctor tells the patient how much to take every given day and whether the patient has any refills. For example, a doctor may need to provide an individual with a saline-based solution. The solution needs the proper dosage of saline to work, and problems can develop if it is too high.

Leaving objects inside the patient

This actually occurs more often than many people realize. There are various small tools doctors need for surgery, such as gauze and sponges. Occasionally, doctors leave behind sponges or other small objects inside a patient. It can take weeks, months or even years for the patient to realize something is wrong, but this typically results in pain around the surgical site. It can result in severe infection, so treatment must happen right away to avoid such complications.

Securing your infant’s future

Securing your infant’s future

Here is some good news for recent mothers: Many birth injuries heal in a matter of weeks, even though symptoms may seem drastic and dramatic. If you worry about an infant’s condition, there may be no cause to doubt the doctor’s claims that the condition is not serious.

However, it is also important to realize that serious conditions may require expensive corrective procedures that still have a long-term effect on your child’s life. You may not be able to calculate all these costs right away.

If you suspect your infant sustained a serious injury, be careful when considering any offers insurance or hospital companies make. It would probably be wise to be especially cautious of any form or other disclosure that you may be pressured to sign. At the very least, you would want to review all the terms for an indication that you could waive any type of rights.

The most common serious injuries you should look out for have to do with nerve damage. If it seems that your infant’s arms or face are not moving correctly, this could be a sign of a bruised or torn nerve. The chances of this particular injury tend to go up if you had a forceps or vacuum-assisted birth.

These injuries are typically the most serious and have the longest lasting consequences. However, they also have some of the least dramatic symptoms. Broken bones, bleeding, bruising and even extremely bloodshot eyes all tend to go away on their own with minimal medical attention. Brachial nerve damage, on the other hand, may require timely surgery for the infant to regain use of the affected limb.

To secure an injured infant’s future, it is often wise to review all agreements you make with medical providers or insurance companies. These initial offers may not represent a full acceptance of responsibility for your infant’s future health.