PVL Birth Injury Lawsuit

Grimes v. The University of Maryland Obstetrical and Gynecological Associates

Cerebral PalsyThis birth injury claim was filed in Baltimore City when a baby was born with periventricular leukomalacia (PVL) as a result of insufficient fetal monitoring and a delayed C-section. It was filed in Health Claims Arbitration on January 17, 2018, and it is the 30th medical malpractice case filed in Maryland this year.

Summary of Plaintiff's Allegations

A 32-year-old pregnant woman was transferred to the University of Maryland Medical System (UMMS) via helicopter after her membranes ruptured prematurely. She was 33 weeks and four days pregnant with complications of gestational diabetes, polycystic ovary syndrome, and obesity. In her two prior pregnancies, the woman also had gestational diabetes with a history of shoulder dystocia (meaning that her babies' shoulders had gotten stuck in the birth canal during delivery).

Upon her arrival to UMMS, the woman was given an ultrasound which showed a healthy and active fetus. The woman remained in labor and delivery for two days before she was transferred to the Mother Baby Unit, leaking amniotic fluid each day. There was no continuous fetal monitoring at any point, instead, the woman received electronic fetal monitoring periodically.

While unmonitored, the woman complained of painful contractions. Once the fetal monitor was placed on the woman, it showed that the baby had a rapid heart rate, variable decelerations (dips in the fetal heart rate), and was in the breech position. The baby was delivered by C-section with a non-reassuring fetal heart rate.

The baby remained in the Neonatal Intensive Care Unit (NICU) for 57 days after birth. A head ultrasound showed periventricular white matter echogenicity consistent with ischemic changes - most likely meaning that the umbilical cord wrapped around the baby's neck, decreasing blood flow to the baby's head and causing brain damage. She was subsequently diagnosed with extensive periventricular leukomalacia (PVL) and has since been diagnosed with cerebral palsy, PVL, cortical visual impairment (CVI), seizures, and spastic quadriparesis.   PVL is a form of cerebral palsy that is caused by a lack of blood flow to a particularly vulnerable part of the child's brain.

Additional Comments
  • Periventricular leukomalacia means periventricular white matter injury. The brain is made up of grey matter, where the brain creates nerve impulses, and white matter, made of axons that transport impulses between different parts of grey matter. PVL is a type of brain damage that occurs when white matter cells die or soften, and the space they used to take up is filled with fluid. Decreased blood flow to the brain is a major underlying cause of PVL, and premature infants are at the greatest risk.

  • PVL it can be associated with a wide variety of causes. Sometimes in the setting of hypoxic-ischemic injury, you could have damage to the white matter, if the patient had an infection. For example, chorioamnionitis can cause it. This can cause periventricular leukomalacia, cerebral palsy and developmental abnormalities. 

  • Periventricular leukomalacia is a pathologic process in an area that is highly susceptible to a multitude of influences not all of which are measurable or predictable. Again, susceptibility in the periventricular region is greatest in extremely preterm infants, and this susceptibility decreases as infants approach full term.

  • During labor and delivery, the risk of an umbilical cord incident is dramatically increased when the mother has ruptured membranes, the fetus is in the breech position, and in the presence of preterm contractions and four-centimeter cervical dilatation at the -2 station. Because the mother and fetus were exhibiting all of these preconditions, their physicians should have understood that close fetal monitoring was especially vital in this case. The doctors couldn't have necessarily prevented the umbilical cord from decreasing blood supply to the baby's head, but they could have intervened with a C-section quick enough that the baby wouldn't have suffered any permanent damage.

  • According to CerebralPalsy.org, 60-100% of infants with PVL are also diagnosed with cerebral palsy, a type of brain damage that results in the loss or impairment of motor function.

Jurisdiction
  • Baltimore City
Defendants
  • Five OB/GYNs
  • The University of Maryland Obstetrical and Gynecological Associates, P.A.
Hospitals Where Patient was Treated
  • University of Maryland Medical System
Negligence
  • Failing to properly monitor and treat the minor claimant.
  • Failing to timely identify to the minor claimant's life-threatening condition and perform a C-section.
Specific Counts Pled
  • The minor claimant sustained a severe and permanent brain injury as a result of her physicians' negligence. She will suffer lifelong developmental delay, trouble with movement, and impaired vision.
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