Hypoxic Ischemic Encephalopathy (HIE) is a severe complication and newborn brain injury that can occur to your baby during labor and delivery. It can result when there is an inadequate blood flow to your newborn’s brain, and thus a lack of oxygen.
(Hypoxic meaning not getting enough oxygen. Ischemic meaning not enough blood flow and encephalopathy meaning a brain dysfunction).
This hypoxic injury can result in severe disabilities in your new born which they will have to deal with for the rest of their life. It can also lead to your newborn’s death depending on the severity of the injury.
How Is Newborn Blood Flow Monitored During Labor And Delivery?
One device used is a fetal monitor. A fetal monitor measures the heart rate and rhythm of your baby/fetus. Fetal monitoring can be done externally or internally. External fetal monitoring involves using a doppler ultrasound to track your baby’s heart rate through your stomach. If there is difficulty tracking your baby’s heart rate externally it can be done internally.
Fetal heart rate monitoring can be especially important if you have a high-risk pregnancy. For example, if you have a high blood pressure or are severely preeclamptic. A baseline or normal fetal heart rate is between about 120 and 160 beats per minute. An indication that there could be an issue with your baby getting blood and oxygen are fetal decelerations.
What Are Fetal Decelerations?
Decelerations occur when the fetal heart rate slows during labor, and this number can drop 40 beats or lower than the normal baseline heart rate. Late decelerations specifically can be a major sign your baby is in distress.
Late decelerations are a gradual decrease in the heart rate usually following a contraction. Their return to the baseline heart rate is also gradual. Late decelerations can be caused by uteroplacental insufficiency. This is when your placenta is not transferring enough blood – and thus oxygen and nutrients – to your baby. Late decelerations can be caused by the mother having low blood pressure, the mother being dehydrated or anemic, rapid uterine contractions, or fetal hypoxia (low fetal oxygen levels).
Decelerations that indicate an issue with blood flow and oxygenation to your baby need to be immediately addressed by the medical team monitoring your labor and delivery at the hospital. There are conservative/non-surgical measures that can be taken to increase blood flow and oxygenation to your baby. However, in some instances conservative measures will not be
sufficient to manage the decelerations appearing on your monitoring. In these instances, a C-Section will be needed to avoid serious hypoxia and ischemic brain injury to your baby. A failure to do a C-Section where there are signs of ongoing fetal distress could be a breach in the standard of care and may be tried as birth injury medical negligence on the part of your delivery team.
What Indications Will There Be That Your Baby Suffered An HIE Injury During Birth?
1.) Apgar Assesment
One measure is an Apgar assessment. Apgar is a quick test performed on a baby at 1 and 5 minutes after birth,
and in some instances at 10 minutes. The 1-minute score shows how well the baby tolerated the birthing process. The 5-minute score shows how well the baby is doing outside the mother’s womb. The assessment measures breathing effort, heart rate, muscle tone, reflexes, and skin color and assigns scores of 0 – 2 for each category.
A 5 minute Apgar score of 7-10 is normal and reassuring; 4-6 is slightly abnormal; and 0-3 is considered low. A consistent score of 0-3 may indicate encephalopathy.
2.) Cord Gas Measurements
Another way to determine if there was a blood flow and oxygenation issue during labor leading to an HIE injury in your baby is to look at the cord gas results. This is done by taking blood from clamped off portions of the umbilical cord. There are two different types of cord gas results – venous and arterial. Umbilical artery blood gas analysis can give more accurate information about the fetal metabolic condition. The gas results will measure pH (the acidity of your baby’s blood), pCO2 (the measure of carbon dioxide within arterial or venous blood), and pO2 (the amount of oxygen gas dissolved in the blood).
One of the most important readings is the pH levels. Normal mean pH levels for an uncomplicated delivery are: arterial 7.24 to 7.27, and venous 7.32 to 7.34. Abnormally low pH levels, especially those under 7, indicates your baby’s blood is acidic and may have suffered a HIE or other brain injury during labor. This is especially so if your baby also has a low Apgar
score, had concerning and abnormal fetal monitoring signs, and had respiratory distress and required intubation at birth.
3.) Post-Birth Baby Brain Imaging
Another way to determine if your newborn’s brain or HIE injury occurred during labor and delivery is by radiology and neuroradiology review of your baby’s brain imaging after birth. Theses experts can determine if your baby’s HIE injury was an acute/more recent one or not. If your baby did suffer an HIE injury they will require immediate treatment known as Head or Brain Cooling Therapy.
Should You Get Help From A Brain Injury Lawyer?
Even with treatment an HIE or brain injury to your baby can lead to permanent limitations in your newborn and may require ongoing and costly medical care for the rest of their life. If the injury is severe enough it could also lead to the wrongful death of your baby soon after birth. If your newborn baby suffered a brain or HIE injury during labor and delivery, and you believe it was caused due to the negligence of the medical team monitoring you, the PA birth injury attorneys at the Thistle Law Firm are here to take your call and answer your questions to help determine if you have a case at 215-568-6800.