Birth Injury Related Medical Diagnosis

Birth trauma generally refers to those otherwise avoidable injuries suffered by a baby during with the process of vaginal delivery. Larger infants, those weighing in excess of 4,500 grams, or approximately 10 pounds, are particularly susceptible to birth trauma injuries. Frequently, babies who are delivered by operative vaginal delivery, which may involve the use of forceps or a vacuum extractor, may suffer birth trauma related injuries. It has been estimated that nearly 50% of all birth trauma injuries are avoidable…

The brachial plexus refers to the constellation of five nerve groups which proceed from the spinal cord in the neck to the shoulders, arms, wrists and fingers. The stretching or tearing of the nerves in the brachial plexus by the careless practitioner during the course of vaginal delivery can cause the partial or total paralysis of the muscles in either the left or right shoulder, arm, or hand. Nerve injuries involving the stretching or tearing of the nerves leading from…

Cephalopelvic disproportion is the medical term typically used to characterize the condition where the fetal head or body is too large to enter or properly pass through the maternal pelvis and birth canal. Cephalopelvic disproportion typically occurs where either the fetal head or body is too large, or the maternal pelvis is too small, to permit the baby to be delivered via a normal spontaneous vaginal delivery. The baby’s head or body may become too large, giving rise to cephalopelvic…

A diagnosis of cerebral palsy can be both confusing and alarming to the parents of an injured child, and many questions certainly spring to mind: What is cerebral palsy? How did this happen to my child? What can be done about it? The term “cerebral” refers to the brain — cerebral palsy results from damage to or developmental problems in the child’s brain. The term “palsy” refers to the impairment of motor function that forms the most obvious outward sign…

Cesarean delivery, sometimes referred to as a “C-Section’, is one of the most frequent surgical procedures performed today in the United States. Between 1970 and 1995, the rate of deliveries by cesarean section was reportedly between 20 and 25 percent on a national basis. Consequently, more and more pregnant mothers who previously delivered a child by cesarean section are now confronted with the question whether it is reasonably safe to attempt a vaginal delivery, referred to as a “VBAC”, or…

During the course of a normal pregnancy, the developing baby remains surrounded by amniotic fluid. It is generally felt that the volume of amniotic fluid will increase during the course of a normal pregnancy until approximately 36 weeks gestation, from which time there will be a gradual decrease. The volume of amniotic fluid is typically assessed through ultrasonography and what is known as an Amniotic Fluid Index (AFI). Decreased amniotic fluid levels during pregnancy, or oligohydramnios, is a condition which…

Despite improvements in obstetrical care and the ability of good health care providers to more closely manage blood sugar levels, diabetes in pregnancy remains a significant medical complication, threatening the well being of both mother and baby. It has long been recognized that the degree of blood sugar control both prior to and during pregnancy will significantly influence the health and well being of the baby. Generally speaking, poor blood sugar control is recognized as posing an increased health risk…

Disseminated intravascular coagulation (DIC) refers to the breakdown of normal blood clotting capacity. Disseminated intravascular coagulation or DIC is also sometimes referred to as “consumptive coagulopathy,” referring to the potentially fatal constellation of factors which can lead to uncontrolled hemorrhage, shock and maternal or fetal death. Although pregnancy typically induces what is characterized as a “hypercoaguable state,” it has long been recognized that several conditions can predispose a patient to the development of disseminated intravascular coagulation or DIC. Placental abruption,…

Eclampsia is generally recognized as constituting an obstetrical emergency which requires prompt medical intervention. Eclampsia represents the neurologic consequences of the most severe form of the disease known as pre-eclampsia, or toxemia of pregnancy. Eclampsia is generally characterized by the occurrence of tonic-clonic seizures or convulsions which are often prolonged and violent. Many patients who suffer from eclamptic seizures also develop brain edema, or swelling, which can result in coma which is often fatal. In other patients, eclampsia can lead…

Erb’s Palsy commonly refers to nerve injuries involving the nerves leading from cervical vertebrae #5 or #6 (C5-6). These nerves are part of the “brachial plexus.” The brachial plexus refers to the constellation of five nerve groups which proceed from the spinal cord in the neck to the shoulders, arms, wrists and fingers. The stretching or tearing of the nerves in the brachial plexus can cause the partial or total paralysis of the muscles in either the left or right…

During pregnancy, the flow of oxygen and nutrients to the baby and the removal of carbon dioxide and other waste gases from the baby is achieved through the placenta. The placenta is an exceedingly complex organ which is comprised of both maternal and fetal blood circulatory systems. Adequate blood flow to and from the placenta, and in both the maternal and fetal circulations, is necessary in order for the baby to receive enough oxygen and for it to be able…

Fetal macrosomia is distinct from the term “large for gestational age” (“LGA”). LGA is defined as fetal weight above the 90th percentile for the baby’s gestational age, based upon growth curves generated from national statistics. In contrast, fetal macrosomia describes a baby weighing more than 4,000 g (about 8 lbs., 12.75 oz.), or more than 4,500 g (about 9 lbs. 14.5 oz.), regardless of gestational age. Thus, a baby weighing 3,900 g at 38 weeks gestational age could be LGA…

Forceps delivery is a mode of operative vaginal delivery in which the forceps are placed around the fetal head in order to permit the application of traction. Traction is applied during a forceps delivery to direct and assist the fetus’ descent through the birth canal. It has been estimated that as many as 10% of all vaginal deliveries involve the use of forceps. More recently, however, many obstetricians frequently utilize vacuum extractors instead of forceps, in part due to the…

It is generally estimated that between 10 to 30 percent of pregnant women may be infected with Group B Streptococcal bacteria, also known as “Group B Strep”. Typically, colonization with the Group B Strep bacteria occurs in the vaginal or rectal areas. Because of the significant maternal and fetal risks associated with Group B Strep infections, in 2002, the United States Centers for Disease Control and Prevention issued detailed guidelines for the diagnosis and management of pregnant women with Group…

“HELLP” Syndrome refers to a grouping of symptoms which represent a severe and potentially life threatening obstetrical emergency, requiring careful obstetrical management. The acronym “HELLP” refers to: H = Hemolysis; EL = Elevated liver enzymes; and LP = Low platelets. HELLP Syndrome is recognized as most typically occurring in patients who have the most severe forms of the disease pre-eclampsia, also known as toxemia of pregnancy. It has been estimates that as many as 20 percent of patients with severe…

Hypertension in pregnancy is generally defined as hypertension that is present either before the pregnancy or hypertension that is diagnosed before the 20th week of gestation. Hypertension which is diagnosed prior to pregnancy is sometimes called “chronic hypertension.” Hypertension which occurs prior to the 20th week of gestation is also sometimes called “pregnancy induced hypertension.” Hypertension is generally defined as a blood pressure greater than 140 mm Hg systolic or 90 mm Hg diastolic. This distinction is very important, since…

Hypoxia is generally characterized as a partial or complete reduction of oxygen in the tissue or major organ systems of the body. Decreased oxygen in the bloodstream is sometimes referred to as hypoxemia. Ischemia is generally defined as a reduction or the complete cessation of blood flow to the body’s tissue or major organ systems. Hypoxic-ischemic encephalopathy refers to a constellation of neurological abnormalities exhibited during the early days of life by a baby who has suffered a hypoxic or…

Intrauterine Growth Restriction or IUGR is a term typically used to describe those babies who fail to achieve normal growth during pregnancy. A common threshold for the assessment of Intrauterine Growth Restriction, is a baby whose estimated weight is less than the 10th percentile of what otherwise would normally be expected. Fetal growth and development is typically assessed by measurements of the uterine fundal height or through ultrasonography. It is generally felt that, up to approximately 30 weeks of gestation,…

Klumpke’s Palsy commonly refers to nerve injuries involving the nerves leading from cervical vertebrae #7 or #8 (C7-8) and thoracic vertebra #1 (T/1). These nerves are part of the “brachial plexus.” The brachial plexus refers to the constellation of five nerve groups which proceed from the spinal cord in the neck to the shoulders, arms, wrists and fingers. The stretching or tearing of the nerves in the brachial plexus can cause the partial or total paralysis of the muscles in…

Meconium is the name typically used to describe fetal fecal matter. The passage of meconium by a baby prior to delivery has been associated with several potentially ominous conditions which require close and careful obstetrical monitoring and management. It has been estimated that as many as 20 percent of all deliveries in the United States are complicated by the passage of meconium prior to delivery. In the vast majority of those cases, it is generally recognized that the pre-delivery passage…

Induction of labor typically refers to the procedure whereby which uterine contractions are stimulated by the administration of the Oxytocin hormone prior to otherwise spontaneous onset of labor, with the goal of achieving a safe vaginal delivery of the baby. Pitocin/Oxytocin is the only pharmacologic agent approved by the United States Food and Drug Administration for the induction of labor for a living baby. Pitocin/Oxytocin is typically administered through an intravenous infusion with the goal of increasing uterine activity which…

Placenta previa is a condition in which the placenta either partially or totally covers the cervical opening, sometimes referred to as the “cervical os.” It is estimated that placenta previa occurs in approximately 1 in every 200 pregnancies. A placenta previa is typically characterized as either: * A complete placenta previa – where the placental tissue completely covers the cervical opening; or * A partial or marginal placenta previa – where the placenta only partially covers the cervical opening. Placenta…

Placental abruption, also called abruptio placenta, is a condition where the placenta prematurely separates from the uterus. It is estimated that placental abruption occurs in approximately 1 in every 120 deliveries accounts for approximately 10 to 15 percent of fetal death. Several conditions have been recognized as being associated with an increased risk for a placental abruption. These include maternal hypertension, advanced maternal age and a prior history of placental abruption. Placental abruptions are characterized as being “total,” “partial” or…

Pre-eclampsia is a disease which occurs during pregnancy and which is characterized by hypertension and proteinuria, or the spilling of protein in the urine. Hypertension is usually defined as a blood pressure greater than 140 mm Hg systolic or 90 mm Hg diastolic, as confirmed by repeat blood pressure assessments. Protein in the urine is assessed through urinalysis, and is usually defined as a urine quantity greater than 0.3 grams of protein in a 24-hour specimen. Many patients with pre-eclampsia…

Preterm or premature labor typically occurs when a mother experiences regular uterine contractions and related cervical changes early in her pregnancy. A “term” pregnancy, is typically considered to be at forty weeks gestation. Preterm or premature labor is recognized as being one of the major causes of injury and death to prematurely delivered babies. Because of this, a safe and careful obstetrician will try to stop preterm or premature labor so that the pregnancy can continue for as long as…

Shoulder dystocia typically arises during a vaginal delivery when, after the baby’s head has been delivered, its shoulder becomes impacted against the mother’s pubic bone, thereby impeding the delivery of the baby’s body. When shoulder dystocia occurs, there is an increased risk of injury to both the mother and her baby. If a shoulder dystocia is not properly managed, the baby can suffer potentially permanent neurologic injuries, such as a brachial plexus injury. Compression of the umbilical cord, which is…

The umbilical cord represents the baby’s lifeline. Through the umbilical cord, oxygenated blood and nutrients are transported from the placenta to the baby. Any disruption in normal blood flow and gas exchange through the umbilical cord can lead to potentially devastating injuries to the baby, including asphyxia and the development of hypoxic-ischemic encephalopathy. An umbilical cord prolapse, or a prolapsed cord, generally refers to a condition where the umbilical cord descends or falls ahead of the part of the baby…

A uterine rupture is a potentially life threatening condition for both mother and baby which typically occurs when the forces and stresses of uterine contractions associated with attempted vaginal delivery cause the uterus to tear open, potentially expelling the unborn baby into the mother’s abdomen. In such cases, maternal or fetal death or fetal asphyxia with associated long-term neurologic impairment are common consequences, particularly in those cases where medical personnel fail to appreciate the risk of uterine rupture or fail…

Vacuum extractors have been increasingly used in the United States to facilitate vaginal deliveries. The increased use of vacuum extractors by obstetricians has corresponded with a parallel decrease in the use of forceps. As a result, many obstetricians who have been trained and exclusive use vacuum extractors have little to no experience in the safe use of obstetrical forceps. The basic elements of an obstetrical vacuum extractor are an attachment device or cup which is typically applied to the baby’s…

For many years, obstetricians were guided by the principle of “once a cesarean, always a cesarean.” Between 1970 and 1995, the rate of delivery by cesarean section was reportedly between 20% and 25% on a national basis. Consequently, more and more pregnant mothers who previously delivered a child by cesarean section were confronted with the question of whether it was reasonably safe to attempt a vaginal delivery, or have another cesarean delivery, in their subsequent pregnancies. In 1988, the American…