Cord Prolapse: Thirty Minutes to Prevent a Lifetime of Disability or Less.
Umbilical cord prolapse is an obstetric emergency that occurs when the umbilical cord slips ahead of the presenting part of the baby after the membranes rupture, becoming compressed between the baby and the maternal pelvis or cervix. When the cord is compressed, oxygen and blood flow to the baby are cut off. Without immediate relief of compression and urgent delivery, typically by emergency cesarean section, the baby can suffer hypoxic-ischemic encephalopathy (HIE), permanent fetal brain injury, or fetal death in a matter of minutes.
Cord prolapse occurs in approximately 1-6 per 1,000 deliveries, and risk is elevated in certain clinical scenarios, such as footling breech presentation, polyhydramnios, multiple pregnancy, premature rupture of membranes, and artificial rupture of membranes with a high presenting part. When any of these risk factors are present, the clinical team has an obligation to be particularly vigilant for the development of prolapse after membrane rupture. When they are not, and when the response to prolapse is delayed, preventable catastrophic injury results.
Our entire legal team is focused on one word: You. You are the most important part of our practice: you, your family, your suffering, your livelihood, and your needs. Let us put our passion for helping others to work for you.
How a Cord Prolapse Case Becomes a Malpractice Claim
- Failure to perform fetal heart rate auscultation or EFM immediately after spontaneous or artificial rupture of membranes, the moment most likely to reveal prolapse through sudden severe bradycardia
- Delay in diagnosing prolapse after a sudden non-reassuring fetal heart rate change
- Failure to immediately relieve cord compression manually while emergency delivery is being arranged
- Artificial rupture of membranes (AROM) is performed with an unengaged presenting part, creating the conditions for prolapse, and then a delay in response when prolapse occurs
- Delay in calling the emergency team and transporting to the operating room
- Failure to achieve delivery within the time required to prevent irreversible brain injury
The Emergency Response Standard
When cord prolapse is diagnosed, the accepted standard of care requires immediate manual elevation of the presenting part to relieve cord compression; rapid transport to the operating room; continuous maternal and fetal monitoring during transport; positioning (knee-chest or Trendelenburg) to reduce compression; and delivery by emergency C-section as rapidly as possible, ideally within 30 minutes of diagnosis, though the urgency of the clinical situation often demands even faster action. In the operating room, cord compression must be maintained until the baby is delivered. Any delay in any of these steps can translate directly into additional minutes of oxygen deprivation and additional brain injury.
Frequently Asked Questions
What causes a birth injury?
Birth injuries can occur for a number of different reasons. In some cases the child’s head is too large to fit through the mother’s pelvis. Other times the placenta become detached prematurely or the umbilical cord is compressed or twisted. Also, when a physician uses forceps or a vacuum during a vaginal birth, injury to the brain can result. In many of these instances time is of the essence. The doctor is responsible for knowing when a cesarean section is necessary in order to avoid injury to the child.
There is no way to completely eliminate the risk of birth injury, but some risk factors that can lead to trouble during child birth are drawn out labor, atypical positioning of the baby, too much Pitocin given to the mother, larger than average sized baby, premature birth and the use of forceps or vacuum.
Expectant parents tend to anticipate a relatively smooth birth process and a healthy baby. In the majority of cases this will be the outcome. Sadly, there are some instances where birth injury and possible lasting effects will result. If you or a loved one has a child affected by a condition that was caused by birth injury and you believe it resulted from negligence on the part of the medical staff, we can offer a free assessment of your case. We have extensive knowledge in the areas of birth injuries and medical malpractice, and will be happy to advise you of your options moving forward.
What is birth injury malpractice?
Medical malpractice relates to birth injury in cases where the medical professional charged with you and your baby’s care fails to provide appropriate care during pregnancy, during the delivery process, or shortly after the child is born.
To better understand birth injuries and how they can be caused by medical and/or nursing mistakes, first you need to understand the concept of medical malpractice. The following will explain what medical malpractice means, statistics and some general tips for selecting the right doctor and avoiding medical mistakes.
A birth injury is an injury that can happen prior to birth, during the labor and delivery process, or in the neonatal or “newborn” period. Injuries that occur during the prenatal period can be attributed to untreated infection such as Group B Streptoccoccus, placental insufficiency or abruption, and preterm birth causing respiratory distress and brain hemorrhage.
Labor and delivery injuries can be caused from a health care provider failing to recognize fetal distress during labor signaling decreased oxygen being delivered to the baby’s brain resulting in injuries to brain structures responsible for movement, cognition, vision, swallowing, and coordination. Additional injuries that occur during labor and delivery can be related to CPD or “cephalo-pelvic disproportion” whereby the baby’s head is too large to fit through the mother’s pelvis during the birthing process.
Did you know?
Rasansky | McKenzie Law negotiated a settlement of more than $10 million on behalf of an infant who was diagnosed with cerebral palsy as a result of medical and nursing malpractice. We have also obtained numerous multi-million dollar settlements for children who suffered other types of birth injuries caused by medical malpractice.
What should I do if my child suffered a birth injury?
The first and most important issue to deal with after a birth injury is caring for the health of the baby and the mother. Get advice, treatment, and support from medical professionals you trust, and do not be afraid to get a second opinion. Also, be sure to take advantage of counseling and therapy options if you or your family needs help processing what happened.
After the health and well-being of your family is under control, you may wish to speak with a Dallas birth injury lawyer. A medical malpractice attorney can help you better understand what caused your baby’s injury, collect the evidence of the case, and enumerate your legal options if you choose to take action.
A birth injury is traumatic for the entire family – and one mistake in labor and delivery can lead to a lifetime of medical costs, nursing care, disability, and therapy. If you believe that your child’s injury was caused by negligence, you owe it to your family to ensure that the person or hospital responsible for your child’s injury pays for the consequences of their negligent actions. If someone else caused the injury, why should the financial burden be placed on your family?
Is my child entitled to compensation?
Typically, it is not the parent but the child who will be awarded compensation, as it was the child who was injured by the doctor’s negligence making the child entitled to compensation. If you win your birth injury claim/lawsuit against the doctor/hospital, compensation is usually delivered in the form of a trust. Keep in mind though that parents can sue for emotional distress—or if the mother was also injured because of the doctor’s behavior. If the child dies because of a doctor’s negligence, the compensation goes to the parents.
What are the main types of birth injuries?
There are many types of injuries that can occur during pregnancy and delivery, ranging from minor to severe. Among the most common types of birth injuries are:
- Cerebral palsy.
- Brachial plexus injuries (Erb’s palsy, Klumpke’s palsy).
- Infections (B strep, meningitis).
- Baby brain damage.
- Bruising and bleeding beneath the cranial bones.
- Bone fractures and nerve damage (often to the upper arm).
- Shoulder dystocia.
- Spina bifida.
- Folic acid deficiency, anemia.
- Persistent Pulmonary Hypertension.
- Blood flow and/or oxygen being cut off to the baby during delivery (causing anoxic brain injury, hypoxia, birth asphyxia, or perinatal asphyxia).
- Wrongful death.
Will my child's birth injury go away?
Birth injuries do not always lead to serious and lasting harm to the child. Many of them will heal on their own with no medical intervention. In some incidences, however, birth injuries result in chronic conditions such as cerebral palsy, Erb’s palsy, or Klumpke’s palsy.
Of these, cerebral palsy is probably the most concerning, as the others do sometimes improve or resolve. Cerebral palsy can affect coordination, reflexes, gait, muscle tone, and mental capabilities. In a study among six countries, the incidence of cerebral palsy was estimated to be between 2.12 – 2.45 cases per 1000 births.
If you’re concerned whether or not your child’s injuries will improve, the best course of action is to speak to your pediatrician. If you’d like to have an attorney look into the facts of your case, call us at (214) 651-6100.
Umbilical Cord Prolapse FAQs
Can cord prolapse be prevented?
Not always. Some cases occur spontaneously without warning. However, the risk can be reduced by recognizing high-risk clinical scenarios (footling breech, polyhydramnios, high presenting part), using caution with AROM when the presenting part is not engaged, and immediately checking for prolapse after membrane rupture in any case. When the team performed AROM without these precautions and prolapse resulted, that clinical decision may be subject to scrutiny.
What does fetal heart rate monitoring show in a cord prolapse?
The hallmark finding is sudden severe variable decelerations or terminal bradycardia immediately after membrane rupture. When the fetal heart rate tracing shows a sudden, dramatic change, and the clinical response is slow, the medical record becomes powerful evidence. The time from the first appearance of the abnormal tracing to delivery is a central metric in cord prolapse litigation.
If your baby suffered brain damage, cerebral palsy, or HIE after a cord prolapse that was not responded to quickly enough, the Dallas birth injury attorneys at Rasansky | McKenzie Law are ready to investigate. Free consultation, contingency fee.
