Signs of Fetal Distress: What To Look For

No one wants to think of their baby in distress. However, it is imperative to be well versed in the possible problems that can arise during labor, both for your own health and to make sure your child’s health is safeguarded. If something does happen, being well-informed can be the difference between receiving the compensation you may be owed, and receiving nothing.

Signs and Symptoms of Fetal Distress

Fetal distress specifically refers to oxygen deprivation, most often during labor, though it can occur toward the end of pregnancy at well. The occurrence rate is hard to pin down. Estimates range from 1 in 25 to 1 in 100; whatever the rate is, however, it is common enough to be a concern in most deliveries.

Symptoms are somewhat difficult to notice without a fetal heart monitor – the most common symptom of fetal distress is a drastically reduced heart rate and rate of movement in utero. If you are near your due date or overdue, another sign is your baby passing meconium (essentially the first bowel movement) while still in utero. However, it is possible to be pro-active if you notice any potential risk factors in yourself during the pregnancy. Significant risk factors that increase the possibility of fetal distress are:

  • Pre-eclampsia, a condition which raises the maternal blood pressure significantly;
  • Hydramnios, which is having too much amniotic fluid;
  • Having a multiple birth; and
  • Being over age 35.

If your baby does become distressed before or during labor, the most common remedy by far is immediate delivery, usually via cesarean section. However, if that is not immediately viable, it is suggested that you lie on your left side to reduce pressure on major veins that may feed the placenta.

Oxygen deprivation can result in difficulties for your child, and it is important that your medical professional be ready to deal with any or all of them. If they have delayed too long, even by a second, it can change your child’s lifelong prognosis.

Electronic Fetal Monitoring (EFM)

One of the most reliable and common methods of verifying fetal health is electronic fetal monitoring (EFM). Reading a fetal monitor strip is quite complex and can usually only be done by medical professionals; failure to do so or failure to do so correctly can be the basis for a medical malpractice case.

EFM can be done in two methods, internal and external. External is done with a hand-held Doppler ultrasound, while internal is done with an electrode directly on the head of the fetus. There are several opportunities for medical mistake here, including using excessive force in placing the electrode. EFM is usually a tool used in court to point to a clean bill of fetal health before an alleged act of negligence, but it can also cause problems in itself.

Get An Attorney On Your Side

Fetal distress can be life-changing for you and your child. If it has happened to you or someone in your family, an attorney can help you receive the compensation you are owed. The experienced attorneys at Meinhart, Smith & Manning, PLLC are well versed in medical malpractice and negligence law, and we will fight for you. Contact our Louisville office for an initial consultation today.

Posted in Personal Injury

Prolapsed Umbilical Cord: Signs and Problems

Delivering a baby is both common and highly technical for an obstetrician. As such, there are countless problems that can occur during the process, yet a doctor will have trained for many years to anticipate them. A prolapsed umbilical cord is one of the most common problems, but also one of the most potentially dangerous. Still, it is often grounds for a medical malpractice claim because its damage is largely preventable.

Signs of Trouble

While there are many different problems that can occur with the umbilical cord, a prolapse is specifically when part of the cord slips down into the mother’s cervix before the baby makes an appearance during delivery. This can cause fetal hypoxia, or lack of oxygen, which can lead to brain damage and in very rare cases, stillbirth. It only occurs in around 1 of 300 births, though some figures point to as few as 1 in 500.

Since a prolapse happens so quickly, most of the time the only warning will be the mother actually being able to feel the cord in the birth canal. Sometimes, signs of fetal distress can be seen on the heart monitor, but not always. Fetal monitoring is critical to be able to remove the cord in sufficient time to prevent injury – any medical professional who does not closely monitor the fetus is in breach of the prevailing standard of care.

The risk factors for a prolapse include breech birth (when the baby is situated feet first), hydramnios (too much amniotic fluid surrounding the fetus), and having either multiple babies or a premature birth. Any or all of these can increase your risk for a prolapse by up to 50%.

Accepted Remedies

The most effective way to eliminate the risks posed by an umbilical cord prolapse is to order a cesarean delivery, and to do so quickly. There may be rare instances where a vaginal delivery will be faster, but the general rule is that a cesarean will be quicker and will put less pressure on the baby’s head. In your situation, it may be beneficial to try and get a sense of how far along your delivery is – if it is very close to completion, a vaginal delivery may be best.

If you are not in the hospital when the prolapse occurs, the accepted advice is to get on your hands and knees for as long as possible. This position reduces the gravitational pull on the baby’s head, and may prevent hypoxia from occurring for a short period of time.

It is important to keep in mind that while sometimes a prolapse is obvious, doctors cannot always distinguish between a prolapse and another source of fetal hypoxia. If the cord is under the baby, for example, no signs may show up on fetal monitoring at all. If there are signs visible that ought to tip a doctor off to a possible prolapse, a failure to diagnose may render them liable – but of course, no doctor can anticipate every issue.

We Can Help Set Things Right

If your child has been harmed by an umbilical cord prolapse, the birth injury attorneys at Meinhart, Smith & Manning, PLLC may be able to help. We have years of experience in the medical malpractice field, and we will do our best to get your family the compensation you are owed. Contact our Louisville office today for a free consultation.

 

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Periventricular Leukomalacia: Holes in the Brain

Lack of oxygen to the brain can cause all manner of problems, and it can be doubly agonizing when one second too long is the difference between a healthy child and a child with physical or mental difficulties. One of the worst types to deal with is referred to as periventricular leukomalacia (PVL). PVL causes brain damage by affecting the white matter, and can be debilitating.

Medical Facts of PVL

periventricular-leukomalaciaPVL almost exclusively affects fetuses and newborn babies, with premature babies being at even higher risk. The disease attacks the white matter in the brain – the part that transmits to the spinal cord – most commonly around fluid-filled areas called ventricles. Around these ventricles, tissue dies, leaving ‘holes’ – not literally, but pockets of dead tissue where no function is possible. Since the tissue dies, the nerves in that tissue die as well.

There are usually no outward signs of difficulty, but babies who have experienced PVL are prone to disabilities like cerebral palsy and muscular dystrophy. It is very common to have tight, stiff muscles that are difficult to move, especially if the damage is severe – the nerves which control motor movement can be affected. Intracranial bleeding may also occur, which can make any existing brain damage far worse. Despite this, many are unaware that PVL can appear in very mild forms. Even if someone is not profoundly affected, they still may have PVL, and it may be due to someone’s negligence.

Diagnosis and Treatment

Many times, PVL can mimic the symptoms of other diseases, so diagnosis is very difficult. It is diagnosed most commonly by either MRI or via a cranial ultrasound. However, a medical professional must know what to look for. If he or she does not, that can still be persuasive in arguing that the standard of care has been breached.

In terms of treatment, there may simply not be anything that can be done. The symptoms can be managed, but the underlying brain damage is usually irreparable. Individual treatment plans tend to be the most effective, if only because PVL can manifest in such a variety of ways. However, some treatments for adult PVL patients have actually proven harmful to newborns, because the newborn’s brain is still developing and changing. It is imperative that your child’s doctor be aware of which treatments are safe to try. A full medical workup is mandatory, and only when all available information is present should a medical professional make any decisions.

While the onset of PVL may simply occur – there is, for example, a documented period of vulnerability for fetuses between 26 and 34 weeks, where the risk is simply higher – it does occur due to medical malpractice. It is distressingly plausible for a doctor to miss, for example, a trapped umbilical cord, or wait just a second too long to insist on a cesarean delivery for a baby experiencing shoulder dystocia (or otherwise trapped in the birth canal). It is a common defense tactic to insist that this area of medicine is simply too unsettled to establish a firm standard of care, but there are signposts in PVL care that a physician must meet, such as exercising all due diligence to avoid any oxygen deprivation in the fetus.

We Can Help Your Family

Having a disabled child can be difficult both monetarily and psychologically. However, if your child’s injury was due to medical mistake, you may be able to seek compensation. The birth injury attorneys at Meinhart, Smith & Manning PLLC are experts in medical malpractice, and we will do our best for you. Contact our Louisville office for a free consultation.

Posted in Personal Injury

Brachial Plexus, Erb’s Palsy & Klumpke’s Palsy

Birth injuries, by nature, are difficult to process because they take so little to occur; one second too long or one half-inch in the wrong direction can cause significant damage to a mother or child. Nowhere is this more apparent than when dealing with nerve injuries, or palsies. Some are more common than others, and as such, are more often the subject of lawsuits.

Brachial Plexus Injuries

Brachial plexus injuries (BPIs) are a common birth malady, and a good-sized portion of birth injury and medical malpractice lawsuits result from their occurrence. The brachial plexus is a network of nerves stemming from the spine, and given their relatively exposed position around the spinal cord, it is unfortunately all too easy to injure or shock any or all of the nerves.

While there are myriad reasons for BPIs, the most talked-about is the obstetric BPI, which usually happens when, during delivery, the baby experiences shoulder dystocia (where it is awkwardly positioned and its shoulders stick in the birth canal). BPIs are usually measured by their severity, which ranges from mild shocks to complete tearing of the nerve. Injuries to differing areas of the nerve network are given different names, and tend to exhibit different symptoms.

Erb’s Palsy & Klumpke’s Palsy

klumpkes-palsyThe two most common obstetric BPIs are Erb’s and Klumpke’s palsies, named for their discoverers. Children diagnosed with either make up a significant proportion of birth injury lawsuits, because it can be very easy to miss the signs, and the condition can set in with little to no warning.

Erb’s palsy is the name given to an injury sustained in the upper area of the brachial plexus. It most often leads to difficulties in moving one’s shoulder and elbow, and may be mild or severe. It only occurs in approximately 1-2 babies per 1000, but when it does occur, it can be due to medical negligence. If a BPI affects both the upper and lower regions of the brachial plexus, it encompasses more than would normally be called Erb’s palsy, and is usually called a ‘universal’ or ‘global’ BPI. Erb’s, however, is in the upper quadrant only.

Klumpke’s palsy, as one might assume, is the name for an injury in the lower half of the brachial plexus network. It affects the hand and forearm most commonly, sometimes giving rise to an appearance of one hand being gnarled or clawed.

Both of these maladies have the possibility of a full recovery. However, depending on the severity of the nerve damage (the most severe is called an avulsion, and it is a complete tear of the nerve away from the root), some may not be reparable unless immediate surgical attention is provided. Failure to do so may be grounds to allege a failure of care.

Contact A Birth Injury Attorney

If your child has sustained a BPI due to medical negligence, we can help. The attorneys at Meinhart, Smith & Manning, PLLC have a long history of success in medical malpractice and other negligence cases, and we will put the lessons we have learned to work for you. Contact our Louisville office today for a free consultation.

 

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Infections During Childbirth

Even with the best prenatal care and the best doctors and nurses overseeing a pregnancy, it is still possible to contract an infection before, during or after delivery. Infections are insidious, and can strike without warning. Sometimes, they happen because of one mistake. It is always a good idea to make sure you know what is normal in these situations and what is not, so that you can react accordingly.

Chorioamnionitis

The most common infection found in women who have just given birth is called chorioamnionitis or intra-amniotic infection (IAI). IAI happens most often from irregularities in the genital tract, and it affects the amniotic fluid and placenta, as well as the chorion and amnion, which are membranes that surround the embryo as it develops. It occurs in roughly 5% of women at the time of delivery.

Symptoms include fever, a foul-smelling discharge, uterine tenderness, and, most severely, tachycardia (a faster-than-normal heart rate) in both mother and baby. Most often, it will occur if labor is very long; the longer the labor, the more chance there is of bacteria beginning to form in the urinary and genital tracts. This can happen spontaneously, but it is plausible that it could occur as a result of medical mistake – taking longer than one should, for example, to decide to attempt a cesarean delivery instead of a vaginal delivery.

Most of the time, IAI does not result in any long-term issues for mother or child; fertility is usually not compromised and the child will make a full recovery. In rare instances, however, children may develop neurological impairments or chronic physical issues (such as asthma or cerebral palsy).

Other Possible Infections

Another infection often seen at time of delivery is group B streptococcus (GBS). GBS is a bacteria that is actually found in about a quarter of all women, healthy and not. It can, however, cause serious problems, especially for newborns if passed from mother to baby during delivery.

GBS naturally occurs in some women, and if you test positive, it does not mean your child will automatically get sick. GBS most often becomes apparent after unusual labor – if your water breaks early (even if you do not deliver), or if you have a fever or UTI at the time of labor, the risk to pass GBS on to your baby is higher. While the risks to the mother are relatively mild, serious GBS can result in diseases like meningitis in babies, or even cause stillbirth.

GBS and other infections like it (such as endomyometritis, which is a type of sepsis usually seen after cesarean sections) can be difficult to tie to any medical negligence or mistake, because both of them have components that naturally occur within the body. It is easy for a defense attorney to claim that the bacteria in a woman’s body simply reacted to normal obstetric procedures, with no negligence occurring. Tests are performed to show the presence or absence of such bacteria, and it is important that you know the results, both for your own sake and possibly for your unborn child.

Get An Expert On Your Side

If you had an infection at delivery and it resulted in harm to you or your child, you may be entitled to compensation. The experienced birth injury attorneys at Meinhart, Smith & Manning, PLLC are well versed in this area of law, and have a long history of success. Contact our Louisville office today for a free consultation.

Posted in Personal Injury

Signs & Symptoms of Cerebral Palsy

When a child is born with a disease or condition, such as cerebral palsy, it can be difficult for parents. While a diagnosis of cerebral palsy will not change the love most parents have for their children, it is still entirely understandable to want answers, especially if the child’s injury might have been caused by someone’s negligence. Understanding the nature of what cerebral palsy is and its related symptoms may be a good first step to determining if it was caused by the negligence of a medical provider.

Symptoms & Causes of Cerebral Palsy

Cerebral palsy (CP) is a generic term for a set of nerve and muscle problems that occur in young children and do not improve with time. Some cases may also involve cognition issues and epilepsy, but this is not required for an accurate diagnosis. While causes and signs will vary, there is a core group of symptoms that generally appear in most cases. These symptoms include:

  • Impairment of muscle tone. This can result in spasticity (stiff muscles and exaggerated reflexes), or general rigidity. Generally, any abnormal posture can occur with CP.
  • Delays in reaching childhood milestones like standing, walking, and crawling.
  • Difficulty with tasks that involve using the mouth, such as sucking or eating.
  • Delays in speech and cognition.
  • Problems with fine motor skills, such as picking up a pencil.

Neurological issues that can crop up, but do not always, include seizures, intellectual disability, problems with vision or hearing, and unusual perceptions of pain (that is, feeling either too much or too little pain).

There are three main subgroups of CP that occur most commonly. The first, spastic CP, is by far the most common, accounting for approximately 80% of cases in the U.S. as of the most recent data available. Spastic CP results in difficulty moving around, holding and letting go of things, and may involve epilepsy or other types of seizures. The second is athetoid or dyskinetic CP, which is primarily characterized by cranial issues – drooling, difficulty swallowing, slurred speech and involuntary movements. The third, the most severe (but also the rarest), is ataxic CP, which appears more as neurological problems. Depth perception, tremors, and balance are most commonly affected by ataxic CP.

The exact cause of cerebral palsy is largely unknown. Research points to a genetic cause in a small percentage of cases, but most are believed to occur due to trauma to fine motor centers either in utero or during birth. Approximately 1 in 764,000 people in the United States have some form of CP, with almost 500,000 of that number under the age of 18.

Medical Malpractice and Cerebral Palsy

Sometimes Cerebral Palsy simply occurs, with no malpractice present. However, birth injuries do account for a significant percentage of cerebral palsy cases. Some of the most common reasons for a later diagnosis of cerebral palsy fall under the rubric of failure to diagnose, such as failure to discover a prolapsed umbilical cord, while others are characterized simply as medical mistakes.

Failure to diagnose is not always grounds for a medical malpractice lawsuit, but it can be if the underlying condition is one that any trained medical professional should be able to detect. Missing a diagnosis that would be elementary for most professionals goes toward an accusation of not meeting the prevailing standard of care – of failing to treat a patient as well as other medical professionals would.

Medical mistakes are a somewhat different picture. This category would include factors such as not ordering a timely cesarean section, if the child is in distress. Medical mistakes go toward imputing negligence to the attending physician or nurse (or midwife, in some states, though they are regulated differently than M.D.s), and proving negligence is a critical component in winning a medical malpractice suit.

Contact A Birth Injury Attorney

An injury to a child is always difficult to deal with, and if it was caused by another’s negligence, it can be even harder. The attorneys at Meinhart, Smith & Manning, PLLC have years of experience in these kinds of cases, and we work hard to get our clients their due compensation. Contact our Louisville office today for a free consultation.

 

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What is a Shoulder Dystocia Injury?

When a child is being born via natural delivery, there are many ways that something could go wrong. One of the most difficult and frightening problems that a mother and baby can experience during labor is something called shoulder dystocia. While there is almost no way to predict it, it does happen with regularity in delivery rooms, and it can either wind up a minor inconvenience, or it can cause severe difficulties.

Medical Facts about Shoulder Dystocia Injuries

Shoulder dystocia occurs when a child’s shoulders become lodged or stuck at the entry to the birth canal during delivery. However, sometimes it is hard to pin down when shoulder dystocia is actually occurring. Is it only in cases of time delay? Or is it whenever a physician finds that the child cannot normally be delivered (that is, with only minimal downward pressure)? This is important because without a definition of the malady, it is hard to define a standard of care. If one court says that shoulder dystocia requires a time delay in delivery, this may alter a plaintiff’s chances for recovering compensation in a medical malpractice case.

The major maternal risk factors for shoulder dystocia are gestational diabetes, abnormal pelvic anatomy, and being short in stature. There is also some evidence that induced labor has a slightly higher rate of shoulder dystocia. General factors include a long labor and possible fetal macrosomia (in other words, a baby that is much larger than average for its stage of development).

Mitigation and Complications

If shoulder dystocia does occur during a standard vaginal delivery, questions arise regarding the obstetrician’s next move. There are several maneuvers that are considered standard procedure in these cases, and an obstetrician will have been trained in at least one or two of them.

The most common way to assist a child from the birth canal is via traction. However, if a mother or doctor is opposed to traction, the most accepted way to potentially dislodge a baby’s impacted shoulder is called the McRoberts maneuver. The maneuver consists of having the mother pull her legs up until they are resting on her abdomen. This will tilt the pelvis and, in many cases, actually help the impacted shoulder pull free. A study published in 1997 by Benjamin Gherman et al. states that the maneuver alone helped free infants approximately 42% of the time.

Even with the best intentions, however, maternal or fetal injury can result. By far the most common injury sustained to the baby is brachial plexus – that is, nerve damage to the spinal area. However, in extreme circumstances, lack of oxygen to the brain can result, likely due to the umbilical cord becoming trapped. This is dangerous ground for medical professionals; given the lack of clarity around shoulder dystocia and what exactly constitutes the standard of care, one wrong move can lead to ruin.

Know Your Legal Rights

If you and your child have been affected by shoulder dystocia, you may be able to obtain compensation for your pain and trouble. The injury attorneys at Meinhart, Smith & Manning, PLLC are well versed in this kind of law, and we will do our best to help you. Contact our Louisville office for a free consultation.

 

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Family Tragedies: Wrongful Death of the Mother During Birth

The birth of a child is supposed to be one of the most wonderful moments in a family’s history. However, it can quickly turn into a nightmare if proper care is not exercised. If the unthinkable happens, and mother or baby loses their life, understanding the family’s rights can help the survivors obtain some measure of compensation for this horrible loss.

Maternal Death During Childbirth Statistics

The United States, despite its civilized status, has an alarmingly high death rate for mothers during childbirth. The rate is actually increasing, despite advances in science and neonatal care; according to the National Institute of Health, the rate in 1982 was 7.5 deaths per 100,000 births; in 2005, which is the most recent data available, it was 15.1 per 100,000. For African American women, the rate is even higher – 36.5 deaths per 100,000 births as of 2008. This is patently unacceptable. There is no indication that women of color suffer diseases like preeclampsia any more commonly than white women, yet they die significantly more often.

The even more unacceptable fact is that most of these deaths are likely preventable. American data as to causes of death is unreliable in the extreme, often not following up as to a possible cause of death if another event may have intervened. For example, if someone passes away at home after a cesarean section, the death may not be attributed to any pregnancy-related cause. Also, some of these deaths are attributable to malpractice, and are simply never reported because no case is brought.

Causes of Wrongful Maternal Death

Very often, when a woman dies in childbirth, her surviving family decides to bring suit against the doctor or hospital, alleging medical errors and/or wrongful death. Wrongful death occurs when someone loses their life due to the wanton, negligent or reckless acts of another, while medical malpractice is a cause of action brought when a health professional fails to treat a patient according to the prevailing standard of care.

The causes of maternal death in childbirth tend to mirror those worldwide – hemorrhaging (both antepartum and postpartum), preeclampsia and assorted disorders, and heart trouble. More specifically, placenta previa is the most common type of hemorrhaging that turns fatal for mothers. It is defined as an instance when the placenta abnormally implants and shifts so that it wholly or partially covers the opening in the mother’s cervix; it can lead to severe bleeding and may require a cesarean section to ensure safe delivery. It is important to note that the rate of all of these problems does increase in women of color, proportionately to the rise in overall maternal deaths, which suggests that the quality of care they receive may be subpar in some respects. And all of the problems listed previously can, in certain situations, be attributable to medical negligence.

A Wrongful Death Attorney Can Help

If you or a loved one has suffered a loss of this nature, the attorneys at Meinhart, Smith & Manning, PLLC can help. We have years of experience in matters of wrongful death and personal injury, and we will put it to work for you. Contact our Louisville office today for a free consultation.

 

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One Wrong Move: Vacuum & Forceps Injuries At Birth

The delivery of a child is one of the most medically complex acts a doctor learns how to perform. Every second can matter, and every movement must be critically assessed. When deliveries need to be sped up, that action has traditionally been performed with forceps, though as medicine evolves, vacuum extractions have become more common. Nonetheless, both methods can lead to problems. It is important to know your rights if things take a turn for the worse.

Vacuum & Forceps: Uses & Risks

If a delivery progresses normally, in theory there will be no need for forceps or a vacuum extractor. However, there are reasons why a natural delivery would need to be sped up – namely, if the child is in respiratory distress, or if it is stuck in the birth canal. If this is the case, these tools are used to help the child free itself, though whether a doctor uses forceps or a vacuum extractor may simply boil down to personal preference.

Forceps are a tool used to help guide a baby’s head out of the birth canal. It is designed to fit around a baby’s head, though it is absolutely imperative that the doctor know how much force to use. Too much can cause facial nerve paralysis, and implies a breach of the standard of care. Babies delivered with forceps are also much more prone to spinal cord injuries, specifically in the high cervical vertebrae, which are directly below the skull.

Vacuum extractors, by comparison, are touted as a safer tool due to the lack of human force they require. However, the machine exerts quite a bit of force all on its own. In a study of 134 births delivered with a vacuum extractor, 28 infants sustained some degree of scalp trauma, from superficial to serious. There are clearly positives and negatives about both tools.

Specific Injuries

Different injuries are more likely with one tool than with the other, but some are depressingly common with both. Brain injuries resulting in neurological trauma happen in 1 of every 664 infants delivered with forceps, and 1 in 860 delivered with a vacuum extractor. Given the relative softness and elasticity of a newborn’s neck, skull and spinal cord, one can reasonably expect that pressure on that area would lead to problems. Developmental delays may occur with brain trauma, which impair motor skills and can sometimes impair cognitive abilities.

Another very common injury with both methods of delivery hastening is an injury to the brachial plexus (BPI), or the network of nerves around the spinal cord that can restrict movement or other bodily functions. The brachial plexus nerves affect the arms, most commonly the upper arms, above the elbow. There are four types of BPIs: (1) avulsion, which is a complete tear of the nerve from its setting; (2) rupture, which is a tear of the nerve root; (3) neuroma, which is when the nerve becomes surrounded by scar tissue and thus inhibited, and (4) praxis, which means a stretching or tearing of the nerve, but not a complete tear.

The most commonly seen BPIs are Erb’s palsy and Klumpke’s palsy, both of which can affect the arms and hands in myriad ways. It depends which of the injuries to the nerve has actually occurred in each case. For example, a baby who has suffered a praxis may recover the use of the arm muscles within days, weeks or months, while avulsion may render the arm largely unusable, simply because no sensation will reach affected areas.

Has Your Child Been Injured?

Even a temporary injury can have an effect on a child’s quality of life, and it is important to know your rights in order to be compensated fairly if the injury is worse. The birth injury attorneys at Meinhart, Smith & Manning, PLLC know the ins and outs of these cases, and we will put our extensive experience to work for you. Contact our Louisville office today for a free consultation.

Posted in Personal Injury

What is the APGAR Score?

When a child is born, all a parent wants to do is get acquainted. However, there are formalities to deal with. At one minute and five minutes after birth, a test of sorts is given to the newborn to quickly assess his or her health and cognitive function. Named after the anesthesiologist who developed it, the Apgar score is thought to be an accurate way to tell whether a newborn needs immediate medical attention. It is done at every birth in the United States that occurs in the presence of a medical professional.

What The Score Means

Though the test was named after Virginia Apgar, the name is also used sometimes as an acronym for the criteria the test is measuring. A baby’s Apgar score measures five things. They are:

  • Appearance – skin color, et cetera
  • Pulse – Heart rate
  • Grimace response – reflexes and facial response
  • Activity – muscle tone and ability to respond normally
  • Respiration – breathing sound & effort

The total score will be a number out of ten points; ten is maximum, but very rarely scored. A seven, eight or nine is considered normal, with no need for emergency treatment. However, a low score at one minute is not immediate cause for concern – most of the time, the score will improve to normal by five minutes. Low scores are most common if there has been anything unusual about the birth – for example, cesarean section or breech birth.

The score is also meant only to assess immediate health concerns; if your baby scores low, it is not necessarily indicative of any long-term medical conditions.

Legal Ramifications

It is rare, but plausible, that an Apgar score can be falsified or mistakenly recorded by the reporting physician. The test is always conducted by a physician other than the delivering obstetrician, but if there is any kind of relationship, the score may be altered. For example, a recent case in Philadelphia involved an infant with a five-minute Apgar score of 7, but the raw scoring was not documented on the child’s chart. It was later determined that the testing physician was married to the delivering obstetrician, and inflated the score to shield their spouse from any potential punitive consequences.

The main time that an Apgar score can come into question in a civil suit, however, is when it is used as evidence that a child sustained a brain injury or other condition in some other manner than at delivery. Sometimes, in actions for medical malpractice, the defense attempts to use a child’s Apgar score as proof that they were in good health while their client had charge of them. For example, if a child is diagnosed with cerebral palsy, but had a listed five-minute Apgar score of 7, the defense can use that as evidence that the diagnosis was not due to any kind of medical negligence.

For example, a California woman delivered a healthy infant with Apgar scores of 8 and 8, though with low platelets. That child later was diagnosed with hydrocephalus and suffered a massive brain bleed, causing neurological injuries. In the ensuing lawsuit, it was alleged that since the infant’s Apgar scores were within normal range, that the delivery was not the proximate cause of the infant’s later bleeding and trauma. The jury disagreed, finding for the plaintiff.

Contact A Birth Injury Attorney

A low Apgar score does not mean a lifetime of disability for a child, but a high Apgar score does not necessarily mean that nothing has gone wrong. If you or a loved one has a child who has sustained a birth injury, we can help. The firm of Meinhart, Smith & Manning, PLLC has years of experience in these cases, and we will do our best to put it to work for you. Contact our Louisville office today for a free consultation.

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