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Roughly
500,000 people in the United States have cerebral palsy. It is one
of the most common of all congenital (present at birth) disorders.
Children who eventually develop cerebral palsy experience injury to
their central nervous system sometime before birth or at birth. This
injury causes changes in the structure of the infant's brain.
Cerebral palsy can be caused by something that happens:
before delivery (the most common time): such as infection,
stroke, diabetes and hyperthyroidism.
during delivery: such as not enough oxygen reaching the fetus.
just after birth: such as a stroke or an infection in the baby.
Fetal Distress
Too often, stillborn births or brain-damaged babies are due to obstetric
personnel failing to diagnose fetal distress early and not taking
emergency measures. Timely diagnosis of fetal distress allows the
distress to be remedied either by treating the underlying cause or
by the prompt delivery of the fetus, such as a cesarean section.
Electronic monitors can detect if a fetus is at severe risk for death
or injury. In many cases, fetal monitoring or other more sophisticated
tests should be ordered.
 Fetal
Heart Rate Alterations
The electronic fetal monitor (EFM) produces two simultaneous tracings
on one strip of paper. The upper tracing represents the FHR; the lower
one depicts each uterine contraction. This allows obstetricians to
assess the fetal heart rate, its deceleration patterns, and its variability.
Interpreting fetal heart monitoring strips is relatively complex.
Heart Rate: The predominant rate on an EFM is called the baseline
fetal heart rate (FHR). The fetal heart rate has a normal range of
120-160 beats per minute (BPM). Baseline rates below that range are
referred to as bradycardia, and rates above that range are called
tachycardia.
Beat to Beat Variability: A normal fetal heart rate has fluctuations
of about six to eight beats per minute. The loss or diminished beat
to beat variability may be an indication of fetal distress.
Acceleration: Increases in the fetal heart rate during contractions
or fetal heart rate during contractions or fetal movement are considered
a sign of well being.
Decelerations: Decelerations (early, late and variable) represent
a decrease in fetal heart rate associated with uterine contractions
or a loss of or diminished beat to beat variability.
Severe Diffuse Brain Injury
Signs and symptoms that typify the newborn with severe diffuse
brain injury are:
• difficulty in breathing
• difficulty in sucking and swallowing
• difficulty in maintaining temperature (persists over 24 hours)
• alterations in levels of consciousness
• hypotonia · abnormal decrease in strength · floppiness
• normal head circumference
• signs of increased intracranial pressure after several days
• high-pitched, shrill cry
• projectile vomiting
• pupil/iris appearing as if it is setting into lower part of
eye apnea
Some signs of an infant at risk for acute brain injury include:
• maternal exposure to drugs or environmental exposure to teratogens
• cord of placenta accidents
• meconium staining of the amniotic fluid
• a low Apgar score at birth that does not promptly rise significantly
with
• vigorous resuscitative efforts
• epileptic seizures
• septicemia in a sick infant
• hypoglycemia
• white or ashen skin tone
• facial abnormalities
Cerebral palsy symptoms include unusually weak or tight muscles, difficulty
with balance, poor coordination, abnormal reflexes, and delay in developing
motor skills such as sitting and walking. About half of children with
cerebral palsy will also develop seizures, and about one-quarter will
have severe mental retardation. Some of these symptoms may take time
to become obvious, especially since cases of cerebral palsy can range
from severe to mild and almost unnoticeable.
The configurations of muscles in children with cerebral palsy can
cause problems with bones, muscles, and joints.
Diagnosis and Treatment of Cerebral Palsy
Cerebral palsy is sometimes diagnosed at birth, or the diagnosis may
not be made until a child is 2 or 3 years old. Physicians use a number
of clinical tests to make the diagnosis.
Physical therapy to improve strength, range of motion, and joint mobility
is the mainstay of treatment. Braces are often used to keep joints
in appropriate positions. Medications can also reduce symptoms. Surgery
is sometimes used to treat the problems that may develop as the child
grows.
Hypertensive Disorders in Pregnancy
Hypertensive disorders are one of the most commons causes of maternal
death, fetal death or fetal injury. Preeclampsia can prevent the placenta
from getting sufficient blood and can cause the placenta to be damaged
infarct or in extreme cases may cause a placental abruption. Eclampsia
or seizures is also a risk.
Most cases of medical negligence arising out of preeclampsia involve
a failure on the part of the physician to recognize that the mother
was severely preeclamptic and consequently the fetus and/or mother
were harmed.
HELLP Syndrome
HELLP syndrome is a progression of severe preeclampsia. It occurs
in about ten percent of women with preeclampsia and is misdiagnosed
as hepatitis, gall bladder disease or TTP. Symptoms include nausea,
vomiting, upper abdominal pain and headache. Medical negligence frequently
involves a misdiagnosis or a failure to order appropriate tests in
time.
Fetal Growth Retardation
Fetal growth retardation may result from placental insufficiency,
cord abnormalities, hypertension, diabetes, genetic causes or other
conditions. Most cases of medical negligence involve a failure to
timely deliver the fetus before it got into significant distress or
a failure on the part of the physician or hospital to adequately monitor
the fetus to determine its status.
Conclusion
Litigating cerebral palsy and obstetrical malpractice cases is a unique
subspecialty that requires an attorney with special knowledge and
skills. Gervelis is experienced in successfully handling cerebral
palsy and obstetrical malpractice cases.
Time is of the essence in investigating, obtaining and reviewing facts,
medical documents and statements, and in preparing your case. If you
know, or suspect, that your baby has cerebral palsy, call Gervelis
Law Firm or another law firm without delay.
For more information and support groups, contact the United Cerebral
Palsy
Association: www.ucpa.org, telephone:
(202) 776-0406, (800) USA-5UCP
(872-5827) and the National Institute of Neurological Disorders and
Stroke:
www.ninds.nih.gov
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