What Happened?

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What Happened?


 

    Sometimes those two words are shouted in anger, or sobbed, or they’re a demand, or whispered in despair. Sometimes the words are said to God, or the world in general, or a doctor or nurse, your spouse, your best friend—someone who might know the answer or help you find it, or just offer comfort in your confusion.

    Sometimes the response, from those you expect to know the answer, will be the myths: We just don’t know. There is no way to know when or how this brain injury occurred. Most cerebral palsy , brain damage or developmental problems are either genetic or were caused by something you did during your pregnancy.


    The truth is this: The main reason we never learn what caused the brain damage is that no one wants to spend the time, energy or resources to find out what really happened.  

    The solution: Insist on answers. Call us. We can help you figure this out. A very large number of these cases are preventable. We can work together to help tragedies from happening to other people. If your baby really is at genetic risk of harm—you need to know.

    What we do know is that when a brain injury occurred can be readily determined by a competent neuroradiologist. A neuroradiologist is a physician who has trained in general radiology and then done several more years of training relating to studies of the brain and spinal cord. The great majority of MRI's, CT scans, and ultrasounds of the brain are interpreted by radiologists. These well meaning physicians are trained in radiology, but have relatively little training in using neuroimaging  studies to time brain injuries.  Neuroradiologists will often look at the pattern of the brain injury and how it changed over time to determine when and how the injury occurred.

 

What the Fetal Strips Tell Us

 

    The labor and delivery records including the fetal heart monitor strips will frequently provide critical information about what may have caused the injury. Fetal monitor strips are obtained by placing two belts on the mother during labor. Below is an example of a normal tracing.  The top portion of the tracing is the baby’s heart rate.  The bottom shows the contractions of the uterus. Competent, appropriately trained labor and delivery nurses and physicians should all be able to read the monitor strips and get a very good picture of what is happening with the baby, especially as it relates to oxygenation of the baby.

 

Fetal Strip 1:

Strip 1



    Various changes in the heart rate and/or the contraction pattern should alert the health care team to potential problems. It is very easy to detect the effects of  excessive Pitocin,  umbilical cord compression, hyper-stimulation of the uterus and other conditions by looking for patterns on the strip. The development of reduced oxygen and its consequences can be detected by changes in the heart rate, by patterns of specific drops in the heart rate (decelerations) or changes in how smooth the heart rate tracing appears (variability). Examples of some of these patterns that may require action by the health care team are set forth below:

 

Fetal Strip 2:

Strip 2

 

 

    Competent, appropriately trained labor and delivery nurses and physicians should all be able to read the monitor strips and get a very good picture of what is happening with the baby, especially as it relates to oxygenation of the baby.

    Strip 2 shows excessive or “marked variability” in heart rate, i.e., the range from the high to the low of the heart rate varies more than 25 beats per minute. This can be an early sign of reduced oxygen to the baby.

    Contractions: This strip shows “hyperstimulation” (more than 5 “bumps” or contractions in ten minutes). Excessive Pitocin can cause hyperstimulation.

 

Fetal Strip 3:

Strip 3

 

 

    Strip 3 shows “absent variability”—the heart rate looks almost flat or smooth instead of the jagged tracings we see on Strips 1 and 2. The baseline fetal heart rate is approximately 190 beats per minute, and anything over 160 beats per minutes is tachycardia.

    The uterine tracing shows hypertonus. The resting tone between contractions is about 40 mmHG. “mmHG” is a pressure measurement expressed in “millimeters of mercury,” which is really all you need to know.  Anything above 20 is elevated. This can also be caused by the administration of too much Pitocin.

 

Fetal Strip 4:

Strip 4

 

 

    Strip 4 shows a “late deceleration” at the far left of the strip, which is a drop in the baby’s heart rate due to impaired delivery of oxygen from the placenta.  There is also reduced variability, i.e., the heart tracing is not as jagged or rough as normal. Again there is tachycardia (accelerated heart rate) at about 180 beats per minute. An elevated hear rate may be due to infection or decreased oxygen.

    This is an ominous tracing. The baby has a profoundly reduced oxygen supply.

    Contractions: The uterine tracing shows hyperstimulation (six bumps) and hypertonus (resting tone of about 45 mmHG). Both are due to excessive Pitocin.

 

    Providing these illustrations is not intended to make you an expert in fetal monitoring but to show you that there are tools available to the health care team which can alert them to specific problems that develop during labor and delivery. In addition, the condition of your baby at delivery and in the days that follow can provide useful clues as to exactly what happened.  Specifically, babies that have  poor tone, color or oxygenation, low blood sugars, poor reflexes, subnormal level of consciousness or seizures may have a post-birth brain injury (more technically, a “neonatal encephalopathy”) caused by something that happened during labor or delivery.  A careful review of all of this information by a trained professional is necessary to determine exactly what caused your child’s injury.