The placenta is a critically important organ during pregnancy. Together the placenta and umbilical cord act as the lifeline between mother and baby. The placenta allows of delivery of maternal oxygen and nutrients to the baby during gestation.
Oxygen is really the key. So many birth injury medical malpractice lawsuits that our lawyers see involve a compromised placenta that is not meeting the child's oxygenation needs. In cases where the problem is easily anticipated or there is signs that the fetus is in trouble, it is incumbent upon the doctors to do something. Often, that is delivering the children via C-section or at least holding the mother for observation so protect against a worsening of the problem or to deal with an acute hypoxic event.What is Placental Insufficiency?
Placental insufficiency (also called "placental dysfunction") is an infrequent but potentially very dangerous pregnancy complication which occurs when the placenta develops abnormally or somehow becomes damaged. The damage or developmental defects to the placenta result in a significant reduction of maternal blood flow to the baby. As a result of this placental malfunction and blood supply reduction, the placenta is not able to supply the baby with sufficient oxygen and nutrients (both of which are normally extracted from the maternal blood flow).
So placental insufficiency means that the placenta is not functioning appropriately in getting oxygen and nutrients to the baby which creates the possibility of inadequate growth and hypoxia. Because placental insufficiency prevents the baby from growing at a normal rate during pregnancy. The undersupply of oxygen and nutrients from the mother's blood leads to serious problems including low birth weight and premature birth, both of which significantly increase the risk of birth injury.
The risk is placental insufficiency can change very quickly. Placental supply and function can change even more quickly with twins, particularly monochorionic amniotic twins sharing the same placenta. (We are handling such a case right now so this is freshly in mind. Mnay of these cases also involve twin-twin transfusion syndrome.)
So if there is a risk that the placental is not adequately supply oxygen and nutrients, that presents a serious risk to the pregnancy. Signs and symptoms of placental insufficiency should ring bells for the doctor and nurses caring for the mother. When it does not, the results can be a tragedy that leads to a medical malpractice lawsuit.About the Placenta
The placenta is an extremely complex organ. A new placenta grows inside the womb with each new pregnancy in the location where the fertilized egg initially connects to the uterine wall. The umbilical cord grows out of the placenta and attaches to the fetus to form a connection between the fetus and the placenta.
Blood from the mother and the fetus circulate into the placenta. The placenta filters nutrients and oxygen out of the mother's blood and basically transfers them into the fetal bloodstream. The placenta also removes carbon dioxide and waste from the fetal bloodstream for disposal by the mother. Finally, the placenta protects the fetus from infection and plays a key role in the stimulation of hormone production.
A normal placenta will continue to grow during gestation. This is necessary because as the baby grows it needs more and more oxygen and nutrients thus increasing the demands on the placenta. By the end of a full-term pregnancy the average, healthy placenta will weigh around 2 pounds. When the baby is delivered at the end of the pregnancy, the placenta is no longer needed and usually comes out shortly after the baby.What Causes Placental Insufficiency?
Placental insufficiency is usually related to maternal blood flow or circulation problems. Pre-existing maternal cardiovascular disorders are a common trigger. Certain medications and lifestyle and dietary habits can also increase the risk of placental insufficiency. The maternal conditions that are most frequently linked to placental insufficiency include:
- Hypertension (high blood pressure)
- Disorders involving blood clotting
- Prescription medications such as blood thinners
- Cigarette smoking
- Illicit drug
Placental insufficiency can also result from other pregnancy complications involving the placenta. The most common placental complications during pregnancy include:
- Placental Abruption: a serious complication in which the placenta suddenly detaches from the uterine wall during pregnancy.
- Placenta Previa: where the placenta is located in the wrong place inside the uterus and is fully or partially blocking the entrance to the birth canal.
- Placenta Acreta: complication occurring where the placenta attaches too deeply into the uterine wall.
Placental insufficiency creates a variety of health risks and complications for the baby during pregnancy. The sooner placental insufficiency occurs during pregnancy, the greater and more hazardous these risks will be. The most significant potential risks associated with placental insufficiency include:
- Oxygen Deprivation During Childbirth: oxygen deprivation is one of the greatest dangers babies face during childbirth and placental insufficiency significantly increases the risk of this occurring during labor and delivery. Loss of oxygen during birth can result in permanent birth injuries such as cerebral palsy.
- Premature Delivery: babies who are born prematurely are at a higher risk for almost every type of injury during or shortly after birth.
- Intrauterine Growth Restriction: IUGR is often a direct result of placental insufficiency. IUGR is a condition in which the fetus is not growing and developing at a normal rate during pregnancy.
Other potential complications with the baby that can result directly from placental insufficiency include hypoglycemia (low blood sugar) and excessive red blood cells.Diagnosis and Management of Placental Insufficiency
Unfortunately, there is no way to fix or cure placental insufficiency when it occurs. It can, however, be effectively managed so as to minimize the risk of harm to the baby. Early and accurate diagnosis of placental insufficiency is absolutely critical to effectively managing the condition and limiting its potential harm.
Diagnosis of placental insufficiency is made based on initial observation of clinical symptoms followed by confirmation with prenatal diagnostic testing. Prenatal tests used to confirm a diagnosis of placental insufficiency include:
- Prenatal Ultrasound: prenatal ultrasound images allow doctors to estimate the size of the placenta and also the size of the fetus, both of which are key factors in diagnosis of insufficiency.
- Blood Work: lab tests on the mother's blood can assess the level of alpha-fetoprotein which is a protein produced by the baby's liver during pregnancy.
- Fetal Stress Tests: fetal stress or non-stress testing can be done to track and assess the fetal heart rate.
Once accurately diagnosed, management of placental insufficiency typically involves treatment of any underlying maternal health conditions (e.g., diabetes, hypertension) that may be causing the insufficiency. Additional management options will also include increased monitoring and steroid injections to accelerate development of the baby's lungs in case early delivery is necessary.Placental Insufficiency Malpractice
OB/GYNs have an obligation to properly diagnose placental insufficiency or other placental complications that may trigger it. Failure to properly diagnose the condition can be grounds for a medical malpractice claim if that failure to diagnose leads to some type of injury to the baby. In our experience, however, placental insufficiency does go undiagnosed very often. The signs of insufficiency are usually fairly obvious and prenatal testing generally allows for accurate diagnosis.
Malpractice involving placental insufficiency is more likely to involve some type of negligent management or handling of the pregnancy or delivery occurring after insufficiency is diagnosed. Most of these claims will involve some type of allegation that the doctors should have pulled the trigger and opted to deliver a baby sooner in response to placental insufficiency.Verdicts and Settlements for Placental Insufficiency
Summarized below are jury verdicts or reported settlements from recent medical malpractice cases involving placental insufficiency.
- Iniestra v Silva (Illinois 2014) $525,000: Baby suffering from intrauterine growth restriction due to placental insufficiency became hypoxic and was delivered stillborn while under the care of defendant OB/GYN. Baby's mother sued alleging that OB/GYN was negligent in failing to order a Level III ultrasound and failing to diligently monitor the baby's prenatal status which would have led to earlier delivery. Jury in Chicago awarded $525k.
- Crowell v Kirner (Pennsylvania 2013) $55 million: Baby is born with damage to brain leading to diagnosis of severe cerebral palsy that will leave her confined to wheelchair and other physical handicaps. Plaintiff's alleged that the injury was the result of a series of errors starting with a failure to anticipate fetal macrosomia which ultimately led to shoulder dystocia and oxygen deprivation during delivery. In defense, the doctors claimed that prenatal blood work testing suggested placental insufficiency so they reasonably expected low birth weight. Plaintiffs disputed that there was ever any indication or diagnosis of placental insufficiency. Jury in Philadelphia agreed and awarded $55 million.
- Stetson v Nunez (New Jersey 2013) $9.6 million: Plaintiff alleged that defendant ob/gyn negligently failed to take measurements of fundal height and this failure prevented doctor from noticing that there was an absence of fetal growth during last stages of pregnancy. As a result placental insufficiency was not timely diagnosed which would have led to earlier delivery of baby before any injury occurred. Instead, delivery was delayed and baby suffered hypoxic brain injury and was diagnosed with spastic cerebral palsy.
- Hodge v Knott (Michigan 2011) $287,500: Baby was delivered stillborn and mother brought malpractice action alleging that the defendant health care entities failed to properly select, train and monitor their employees and failed to adopt and implement policies for the management of a patient with IUGR and placental insufficiency. The case was settled quickly out of court.
If your baby was born with a birth injury in connection with placental insufficiency or a related complication, you have every right to seek compensation from the responsible parties. Contact the birth injury lawyers at Miller & Zois for a free case assessment. Call us at 800-553-8082 or contact us online.