Nothing matters more to a new parent than having a healthy, happy baby. Unfortunately, not all births go according to plan. 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, and includes monitoring:

• 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 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;
• abnormal head circumference;
• signs of increased intracranial pressure after several days;
• high-pitched, shrill cry;
• projectile vomiting; and/or
• 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 or placenta accidents;
• meconium staining of the amniotic fluid;
• a low Apgar score at birth that does not promptly rise significantly;
• vigorous resuscitative efforts;
• epileptic seizures;
• septicemia in a sick infant;
• hypoglycemia;
• white or ashen skin tone; and/or
• 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.

ange 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 often 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. The Gervelis Law Firm is experienced in successfully handling cerebral palsy and obstetrical malpractice cases.

Time is of the essence in investigating, obtaining, and reviewing the facts in medical documents and statements; and in preparing your case. If you know, or suspect, that your baby has cerebral palsy, call Gervelis Law Firm today.

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.