Medical Malpractice
Perinatal and Neonatal Stroke: What You Need to Know
Expectant parents grapple with many fears as they prepare for the birth of a new loved one and potential birth injuries are among the scariest realities to consider. Although we often assume a stroke -wherein poor blood flow causes varying degrees of brain damage– is a health hazard that comes only with old age, the truth is that a number of factors prior to delivery (perinatal) or during delivery (neonatal) have to be considered.
Trauma, according to many defense attorneys, is the least common cause of a neonatal stroke. But negligent forceps use, vacuum extraction, thrombophilia, abnormal positioning, and cephalic pelvic disproportion are considered just a few of the complications that can cause a neonatal stroke.
The exact causes of perinatal stroke are often difficult to identify. Untreated infections and outside influences such as smoking, cocaine use or diabetes are considered potential maternal risk factors. The cause of congenital hemiparesis is most often a focal perinatal stroke
Whatever the precipitating cause, signs of a potential stroke are usually there for a doctor to see. How? The number one way to diagnose a stroke is to identify abnormal fetal monitoring strips. Often, the smartest play is to take the baby out quickly by c-section. Our birth injury lawyers see a lot of claims where if the doctor had simply ordered a C-section, the child’s injury could have been avoided.
Not only can a stroke delay or limit speech and cognitive growth in a child, there is evidence to suggest that those with substantial developmental delay or seizures related to neonatal or prenatal strokes face a shorter life expectancy as well. For many parents, a stroke missed by medical professionals before or during delivery can have a permanent impact on their child’s life. It takes a while to make the diagnosis One-third to one-half of all newborn children with neonatal strokes have a normal newborn record.
Detecting a Stroke
While neonatal stroke occurs in roughly 1 in 12,000 births, perinatal strokes are considered much rarer. As you can imagine, defense lawyers like to pretend that perinatal strokes are more common than they are because they want to argue the injury to the child happened long before the errors made by the obstetrician during delivery.
Approximately 25 percent of the babies that have a perinatal stroke are fatalities. Instances of perinatal stroke are often discovered via ultrasound when a telltale stain appears within the amniotic fluid. If the stroke is severe enough to result in a serious neurological deficit, this is usually apparent upon delivery, If for instance, a newborn infant suffered a right hemisphere stroke then left side extremity weakness will be obvious. Neonatal strokes, however, can remain undetected for as long as a few months after delivery.
Several studies of perinatal stroke have noted an association with prolonged rupture of membranes and chorioamnionitis.
Treatment Options
While comprehensive screening by healthcare providers over the course of the pregnancy is the only way to truly prevent perinatal stroke, many doctors are turning to unusual tactics when it comes to the combatting neonatal stroke. These treatments include deliberately inducing hypothermia to prevent an infant’s brain from overreacting to changes in blood flow and use of Hyperbaric Oxygen Therapy, which immerses a newborn in an oxygen-only environment as a means of counteracting a potential stroke. Certain anticoagulants, such as herapin, are also considered effective methods of treatment.
Sample Verdicts and Settlements in Perinatal/Neonatal Stroke cases
There are not a lot of settlements and verdicts in these cases. Most birth injury lawyers have never litigated a neonatal stroke case. Below are a few example results in neonatal stroke birth injury cases. We have included a settlement, a plaintiff’s verdict, and two defense verdicts.
Massachusetts: Malley et al. v. Sotrel . March 2009. $2.3 million verdict.
During an attempted vaginal delivery, a male infant was unable to pass through an unusually narrow birth canal. While the child was ultimately delivered approximately four hours later via c-section, it was determined that he suffered a prenatal stroke arising from oxygen deprivation and intracranial pressure during the prolonged labor. The child’s parents alleged that this stroke was the result of the initial attending physician’s negligence, specifically his refusal to deliver the child via c-section which resulted in oxygen deprivation. At trial, the defense argued that the stroke had occurred sometime before delivery and was unrelated to any alleged negligence. After a four hour deliberation, the jury returned a verdict in favor of the plaintiffs: The infant received $1.8 million in damages while each parent was awarded $250,000.
New York: Sullivan v. Wright, November 2008. $1.9 million settlement.
After his birth, a male infant was admitted to the intensive care unit with suspected sepsis. While in the ICU, the infant suffered a seizure resulting from a neonatal stroke impacting the cerebral artery. The infant’s mother alleged that the stroke led to some cognition and speech delays during the child’s development. She further alleged that the sepsis and resulting stroke was caused by her treating obstetrician’s failure to diagnose her chorioamnionitis prior to delivery and prescribe antiobiotics accordingly. The obstetrician denied any departure from the standard of care and held that the stroke had occurred prior to delivery during the fetal stage. Prior to the commencement of a trial, the parties agreed to a $1,950,000 settlement paid into an annuity valued at approximately $11 million over the course of the child’s life.
Texas: Cornelison v. Harlingen General Hospital, September 2013. Defense Verdict.
After a 36 hour delivery, a male infant was born and soon after diagnosed with cerebral palsy. As a result, the permanently disabled child suffers from spasms and seizures affecting both the upper and lower extremities. In their suit, the child’s parents allege that the cerebral palsy developed after the mother was administered an excessive dosage of Pitocin (a drug designed to induce labor) which caused a series of contractions lacking the necessary resting tone, resulting in skull compression. At trial, the defense denied this series of events as the root and argued that the infant’s palsy was due to a perinatal stroke with no relationship to the method of delivery. In his report, the defense’s expert OBGYN determined that the infant sustained a series of perinatal strokes un
related to any care provided to the mother before, during or after delivery. In their verdict, the jury found in favor of the defense.
Maryland: Thompson v. Laurel Regional Hospital, March 2012 Defense Verdict.
A fetus suffered a neonatal stroke during childbirth. The OB ordered Pitocin to expedite delivery. Still, the mother spent six to eight hours in labor before delivering her daughter. Plaintiffs alleged that that Pitocin should not have been used because resulted in hyperstimulation during delivery. The child, who was nine-years-old at the time of trial had one-sided weakness and fine motor skills deficits as a result of the stroke. A Rockville, Maryland jury determined that the hospital and the OB were not responsible for the child’s stroke.
Getting Help for Your Stroke Claim
If you believe your child has suffered a perinatal or neonatal stroke that could have been prevented, you may have a medical malpractice case for which you and your child may receive compensation. If you believe this was the situation for your child, call 800-553-8082 or get a free online consultation.
Resources
- Neonatal Stroke is Not a Harmless Condition. AdenU: Stroke 40:1948-1949, 2009.
- The Black Box of Perinatal Ischemic Stroke Pathogenesis. MineykoA and Kirton A: J. Child Neurology 26(9): 1154-1162, 2011.
- Perinatal Stroke in Children with Motor Impairment: A Population-Based Study. Wu YW, March WM. Pediatrics, 114: 612-619 (2004).