Cerebral Palsy Occurring Because of Mistakes or Complications During Delivery or Soon After Birth

Çerebral Palsy can also be caused by complication during delivery or soon after birth. These are the cases where the greatest care needs to be looked at to determine if medical malpractice occurred.

Low birth weight - under 5.7 pounds. the less the newborn weighs and the more premature the birth, the higher the chance of the infant developing cerebral palsy.  Infants born with a very low birthrate (i.e. under 3 pounds 5 ounces, or 1500 grams) have a 25 times more likely chance of acquiring cerebral palsy

Premature birth, less than 37 weeks: premature babies delivered who do not cry within the first five minutes after delivery, babies who cannot breathe on their own and are on a ventilator for more than 4 weeks.

Breech birth: Most babies are in the "head-down" position most of the time by 28 weeks gestation. Breech births happen in 3 to 4% of pregnancies; a breech birth is when the baby’s feet or buttocks enter the birth canal first. Doctor may try to move the baby into a head-down position between weeks 30 and 40 of pregnancy by physically manipulating the baby; this procedure is called an “external cephalic version.” This cannot be performed if the mother has other complications such as: vaginal bleeding, multiple births, premature rupture of the membranes, a very small baby, low levels of amniotic fluid or abnormalities in the baby's heart rate.
A vaginal breech birth is possible, however, complications may arise such as damage to the umbilical cord, which could prove fatal to the baby and/or mother. The umbilical cord may slip pass the feet or buttocks and become prolapsed. If complications develop, an emergency cesarean section is required.
Some women with a breech presentation and other pregnancy complications may opt for a planned C-section.

Cesarean birth

Fetal Distress, respiratory or vascular problems during delivery. not doing a cesarean section when the fetus is in distress or danger = medical mistake; failure to respond to abnormal heart rates = medical mistake

Low Apgar score - infant heart rate, breathing, muscle tone, reflexes, and skin color are each scored as 0 (low), 1 (intermediate), or 2 (normal) after delivery. A total score of 7-10 at 5 minutes is considered normal; 4-6, intermediate; and 0-3, low. Scores that remain low 10-20 minutes after delivery indicate increased risk for CP. “Low Apgar score Infant heart rate, breathing, muscle tone, reflexes, and skin color are each scored as 0 (low), 1 (intermediate), or 2 (normal) after delivery. A total score of 7-10 at 5 minutes is considered normal; 4-6, intermediate; and 0-3, low. Scores that remain low 10-20 minutes after delivery indicate increased risk for CP”

Severe jaundice: Untreated severe jaundice can cause permanent damage to the brain and may result in cerebral palsy. Severe jaundice in an infant or fetus can also lead to the development of CP. failure to recognize or treat jaundice = medical mistake

Bleeding on the brain:

Abnormal or poorly formed organs: If a newborn is born with abnormalities in the heart, kidneys or spine, there is the probability that the brain might also be badly formed

Seizures: Seizures are an indication of abnormal brain functioning; therefore, if the newborn has seizures, there is an increased likelihood that the child will develop cerebral palsy. the failure by a doctor to recognize seizures in the newborn is a medical mistake

Being in the birth canal too long: can lead to oxygen deprivation; medical mistake

Prolapsed umbilical cord: a prolapsed cord means that part of the umbilical cord has come out of the cervix or vulva ahead of the fetus. If the vein is cut off while the arteries are open, the fetus pumps blood to the placenta but will receive nothing in return. This rapidly results in hypoxia (lack of oxygen being supplied) and hypovolemia (shock from reduction blood volume). if the cord is completely compressed, hypoxia will develop quickly. bradycardia (slow heart rate) goes along with the obstruction of umbilical arteries. Prolapsed umbilical cords are often preceded by variable decelerations of the fetal heart rate, demonstrated on the electronic fetal monitor. Medical mistake: failure by a doctor to recognize an undetected prolapsed cord

Vacuum Extraction or Forceps Delivery: The use of forceps or a vacuum extraction occurs in about 10% of deliveries, with the vacuum extractor being more common. These instruments are used in situations where: 1) the baby is not in the right position and is showing signs of distress or 2) when the mother experiences difficulties pushing the baby out either from exhaustion, due to the effects of the epidural or because the baby’s shoulders are especially large (referred to as Shoulder dystocia). "Dystocia" means "a difficult childbirth". Shoulder dystocia can happen with a baby of any size, but is more common in babies with large shoulders.

With a forceps delivery, a doctor uses twin steel blades (forceps) inserted into the vagina and around the baby’s head to assist in delivery. As the mother bears down, the doctor pulls the baby’s head through the vagina. Forceps delivery are usually done only when the baby’s head fails to descend further than the mother’s pelvis, if the mother has difficulty pushing either because of an epidural or exhaustion, or if a baby is in a posterior position or is a breech birth. Forceps are the choice of method in situations where the baby needs to be rotated in order to be born. Forceps may also be called for if the baby’s head is not low enough for the vacuum extraction to be effective. Risks associated with forceps deliveries include: misshapen head, brain damage (i.e., cerebral palsy, behavior problems, mental retardation), or injury to the baby’s head (i.e., scalp lacerations, skull fracture) and spinal cord.

Serious risks associated with vacuum extractions include: While the pump often leaves a bruise on the baby’s head, other more serious complications can result. One is a subgaleal hemotoma (bleeding in the space between the skull and the scalp) and the other is an intracranial hemorrhage (bleeding within the skull).

doctor’s overuse of vacuum extraction, misuse of forceps= medical mistake

Shoulder Dystocia: baby’s shoulders are especially large (referred to as Shoulder dystocia). "Dystocia" means "a difficult childbirth". Shoulder dystocia typically occurs with babies with large shoulders interferes with the mother’s ability to give birth. While shoulder dystocia can happen with a baby of any size, it is more common in babies with large shoulders. OB's can employ a variety of special strategies and techniques to help deliver a baby with shoulder dystocia. But if these fail, forceps or vacuum assisted delivery may be required.

Shoulder dystocia can result in damage to the brachial plexus nerves which control movement and sensation in the arm, hand, and fingers; the damage is most likely the result of the manual stretching of the nerves. Excessive tension may also physically tear the nerve roots out from the infant’s spinal column. Brain damage and/or bone fractures are other types of damage which can occur with Shoulder Dystocia.

During Childhood

1. Infant illnesses

Meningitis: Meningitis is the inflammation of the membranes which surround the brain and spinal cord. Meningitis can be viral or bacterial; the most dangerous being the bacterial form. failure to recognize or treat meningitis = medical mistake

Viral Encephalitis: inflammation in the brain caused by a virus

• Head injury: from falls, car accidents or abuse
• Drowning accident
• Poisoning

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