Philadelphia Birth Injury Lawyer Blog

Philadelphia women trying to get pregnant after a miscarriage should not wait. A new study has revealed that the best chance of having a healthy baby is within six months of the miscarriage. The current recommendation is women wait at least six months after a miscarriage before they try to get pregnant again.

According to the study, 85 percent of women who got pregnant within the first six months of a miscarriage had a healthy baby. Women who waited over two years had a 73 percent chance of delivering a healthy baby. The current guidelines from the World Health Organization state that women should wait six months but the guidelines are based on women conceiving at a younger age. However, current trends suggest that women are waiting longer and conceiving children at a later age. Any further delay in conception can result in a greater risk of a child born with a birth injury.

The older a pregnant woman is the higher the risk of a miscarriage. Miscarriages occur in about twenty percent of all pregnancies but as a woman approaches 40 the rate increases to 30 percent. Most doctors recommend that women try to get pregnant after a miscarriage whenever they feel their body is physically ready and their mind is emotionally healed.

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After miscarriage, don't wait before trying again

Children suffering from spastic cerebral palsy have severe muscle tightness and daily activities such as walking and brushing their teeth are nearly impossible. A surgery called Selective Dorsal Rhizotomy (SDR) may be an option to some cerebral palsy children to loosen muscle tightness in hopes to improve muscle control and movement.

During an SDR procedure, misfiring nerves are severed and in some cases vertebrates are removed. The selective operation alleviates muscle tightness and can correct the gait of cerebral palsy suffers. A successful operation will have all spasticity eliminated but leaves the patient with very weak muscles. After intensive physical therapy, cerebral palsy patients can regain strength in their muscles and perform daily tasks without assistance.

The earlier the operation is performed the greater the results. SDRs are not routinely performed in children over the age of 6 because the older the patient gets the harder it is to alleviate spasticity and the harder the rehab process becomes.

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New guidelines released by the American College of Obstetricians and Gynecologists state that a woman who has had given birth previously by cesarean should be permitted to have her next child vaginally.

Many hospitals practice the rule, "once a c-section, always a c-section" due in part to fear the scar of the previous c-section rupturing during a delivery but the chance of that occurring is less than one percent. The risk is lowered even further due the lower location of the cut performed in today's c-sections.

While c-sections are sometimes necessary and life-saving they come with greater risks than normal vaginal births. Not only are there complications with the procedure, the next pregnancy can be negatively impacted by a previous c-section. The more c-sections a woman has the greater the chance life threatening occurrences such as placenta abnormalities or hemorrhaging.

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New guidelines aim to reduce repeated C-sections

Philadelphia women looking to get pregnant with in vitro fertilization (IVF) should know that there is a heightened risk of their child developing cerebral palsy. Cerebral palsy is more common in children born to mothers that have had assistance in conception such as IVF when compared to women who became pregnant naturally.

The increased risk comes not because of the procedure but because of the nature of IVF pregnancies. IVF pregnancies are more common to have multiple children in one pregnancy and children born prematurely. These two factors elevate the chance of a child developing a serious birth injury such as cerebral palsy.

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Multiplicity and early gestational age contribute to an increased risk of cerebral palsy from assisted conception

Group B Strep is a bacterial infection that can lead to serious injury and death in newborns if they contact the bacteria. Group B Strep can lead to sepsis, a severe infection throughout the body, pneumonia, or meningitis, a severe infection of the fluid surrounding the spinal cord and brain. If an infant develops any of the serious illnesses caused by Strep B they can suffer severe and permanent injuries such as cerebral palsy, brain damage, deafness or blindness, and death.

Three quarters of the infants who are exposed to Group Strep B show symptoms within the first seven days of life. Doctors have discovered that infants infected at this young age normally are exposed to the bacteria during childbirth and delivery. The bacteria can travel up the woman's vagina and infect the baby as soon as the amniotic sac breaks at the onset of labor. The baby can also be exposed when travelling down the birth canal. The bacterium is found in 25% of all women but does not always carry an infection or show signs of exposure.

A failure to diagnose Strep B in a pregnant woman can lead to the unnecessary exposure of Strep B to newborns. This unnecessary exposure can lead to a host of medical problems for the infant include cerebral palsy, brain damage, and other serious injuries.

Valproic acid, a common drug used to treat epilepsy, has been linked to birth defects such as spina bifida and defects in the development of the brain, heart, and limbs.

A study of almost 2,000 live births confirmed that women taking valproic acid during the first trimester were 13 times more likely to have a baby born with spina bifida. Spina bifida is a serious birth defect that occurs when the spinal cord fails to develop properly. An improperly developed spinal cord creates neurological and development problems and delays in children.
Women taking the drug were also at a higher risk to have children with cleft palates, extra digits on the hand or feet, and heart defects. Valproic acid can also cause the fetal skull to fuse early, restricting skull and brain growth.

Doctors who published the study have suggested that all women of child bearing age to stop taking valproic acid and find another drug to combat their epilepsy. Women taken other epileptic drugs showed no increase in the likelihood of a birth injury or defect.

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Epilepsy Drug Linked to Serious Birth Defects

Mannitol, a sugar-alcohol compound, has been found to increase the effectiveness of cord blood used to treat cerebral palsy.

There is no cure for cerebral palsy but multiple studies have shown that symptoms can be eased when treated with the child's own cord blood. The effectiveness of the treatment varies from case to case but a new study has shown that mannitol can help the stem cells of the cord blood reach the site of the injury. A blood-brain barrier exists at the site of cerebral palsy injuries and it can be difficult for the stem cells to reach the injury and correct the problem if this barrier is not broken.

A study split animals with cerebral palsy into two groups, one group received mannitol and cord blood while the other received cord blood alone. All animals showed improvement but those injected with the combination therapy showed greater and more functional improvement than those injected with cord blood alone. Mannitol has shown to help the cord blood break through the blood-brain barrier and help cord blood rejuvenate damaged cells.

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Mannitol Improves Cerebral Palsy Treatment

Recent studies have proven that cord blood can be used to treat a variety of birth injuries, including cerebral palsy. Now a study suggests that waiting to clamp the umbilical cord of the baby can prevent injuries and improve infant health.

In most delivery rooms across the country, including those in Philadelphia, doctors clamp the umbilical cord of an infant seconds after delivery. Clamping and cutting the cord cuts off the flow of blood between mother and child, potentially robbing the infant of the last few minutes of cord blood. Cord blood has been found to contain stem cells that have regenerative properties allowing them to grow into a multitude of different cells.

Immediately clamping and cutting the cord is not harmful to the infant but waiting until the cord stops pumping blood has been shown to benefit the child. Waiting just thirty seconds to clamp the cord has shown a decrease in anemia, brain bleeds, chronic lung disease, eye problems, infections and the need for a blood transfusion.

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Waiting to Clamp the Umbilical Cord May Be Better for Babies

Wait before cutting the umbilical cord, say researchers

Doctors and researchers have found a new indicator of health problems in newborns. A high level of acidity in cord blood can has been linked to cerebral palsy, brain damage and death in childhood. Through testing doctors hope to predict which children need close monitoring as they mature and develop.

Acid is measured on the pH scale. A score of 7 is neutral, below 7 is acidic and a score above 7 indicates higher levels of alkaline. Umbilical cord blood should be extremely close to 7 but complications during birth, such as loss of oxygen, can cause the infant to produce more lactic acid. The increase of lactic acid increases the acidity of the cord blood and predicts the child may have some problems with normal development.

Currently, cord blood is only tested when it is suspected that the child has experienced a lack of oxygen at birth but the links found in this study may see cord blood tested more routinely as a prediction for birthing complications. A lack of oxygen at birth can lead to brain damage or cerebral palsy in newborns of infants. Currently there are no cures for the crippling diseases but any sign or indicator that can inform doctors of potential problems can lead to a quicker diagnosis and treatments that will improve the child's life.

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A new predictor of newborn health: Umbilical cord blood pH

Doctors and nurses at University of Pennsylvania School of Nursing in Philadelphia have created a new tool to help manage the feeding and growth progress of premature babies.

All premature babies begin life in the neonatal intensive care unit (NICU.) In the NICU every detail of the baby's growth is recorded and compared to growth charts to ensure the baby is progressing at adequate levels. Doctors at Penn realized the charts currently used nationwide were antiquated and based on a relatively small set of data and decided to create new charts to better reflect the modern American baby.

Using a national database the doctors created new growth curve charts. The study found a significant difference between the size of male and female babies and created three new charts for each gender. The six new charts are currently in use at the NICU at Penn and doctors hope they will soon spread nationwide to more accurately gauge progress and schedule feedings of premature babies.

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Doctors and researchers have found that a specific cell in the nose that is used with the olfactory nerve can help heal lesions in the central nervous system.

Olfactory ensheathing cells (OECs) support and surround neurons in the nose to help us smell. OECS are known to have exceptional plasticity and promote olfactory blood vessel growth while offering neuroprotection to cells. Doctors have transplanted OECs to the frontal lobe of patients with debilitating neurological disorders such as amyotrophc lateral sclerosis (ALS), multiple sclerosis (MS), and other spinal cord injuries. The unique abilities of the OECs promoted healing in the brains of patients and most saw improvement in their daily lives.

Cerebral Palsy is a similar neurological condition to ALS and MS. Doctors conducted a separate study on children and adolescents with cerebral palsy to determine if the OECs would heal cerebral palsy lesions on the brain. The study found healing in over 80% of participants while not causing any significant side effects. Neurological and functional improvement was also noted in the children who participated in the study.

Doctors are optimistic that as they continue to study the healing powers of OECs they will one day be a realistic and successful treatment to those suffering from cerebral palsy.

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Cell transplants to cure cerebral palsy

Doctors have discovered that babies born with inflammation of the membranes in the placenta may increase their risk of cerebral palsy.

A study found that chorioamnionitis was three times as prevalent in babies born with cerebral palsy when compared to babies born healthy. Chorioamnionitis is a bacterial infection that occurs in the placental membranes which hold the amniotic fluid. This condition can lead to a serious infection for the baby, premature birth or blood poisoning in the mother. When infected, antibiotics are prescribed to control the infection but the baby is usually delivered to prevent any further complications.

Doctors are optimistic that if a further study confirms the link between chorioamnionitis and birth injuries some preventative measure can be taken to lower the child's risk of being born with cerebral palsy.

Doctors have found that exposing babies to xenon gas can help reduce brain injuries suffered by babies born with a lack of oxygen at birth.

The doctors and researchers conducting the xenon gas treatment option were the first to treat newborns with the controversial "cooling method" to reduce the effects of lack of oxygen at birth. With a cooling method the infant's temperature is reduced to lower the oxygen requirement for cells to reduce injury and delay the death of cells. The same doctors who pioneered the "cooling method" are now testing the role xenon gas has in preventing permanent injuries in newborns such as cerebral palsy.

For almost a decade the doctors have proved in the lab that xenon gas doubles the protective effort of cooling the brain in babies born with birth injuries. The problem was the scarcity, cost and delivery of the gas to the newborn. To remedy the problems, the doctors created a "closed circuit system" that is fitted to an incubator to deliver the xenon along with appropriate amounts of oxygen to the newborn. The system works by recycling the xenon that is not absorbed by the infant and pumping it back into the incubator.

The system has greatly reduced the cost of the treatment and has shown promise in the few infants who have tested the system. Doctors and researchers are gearing up for a clinical trial that will hopefully yield positive results and make xenon treatments routine and inexpensive for babies born with birth injuries.

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First baby given xenon gas to prevent brain injury

Magnesium sulphate injections given to mothers experiencing a preterm birth may help prevent the infant from developing birth injuries such as cerebral palsy.

Babies before 30 weeks of gestation pose a much higher risk of developing cerebral palsy than babies born at full gestation. After several trials over a 14 year period doctors and researchers recommend that mothers begin receiving doses of magnesium sulphate by injection within 24 hours of delivery if they are experiencing preterm labor.

The health community is unsure of exactly how the magnesium sulphate protects the brain but the compound is critical to normal cell function, can improve blood flow and may protect cells against harmful molecules. The injections pose no serious side effects or complications to mothers or infants. Some minor side effects to delivering mothers include: sweating, flushing, nausea, vomiting, headaches and palpitations.

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Magnesium protects fetuses

Botox is becoming a common treatment option for patients with cerebral palsy and is even used at Children's Hospital in Philadelphia but this use may also be harming patients.

Botox is commonly thought of a medication used to treat wrinkles in senior citizens but doctors and researchers and seeing its extended benefits in treating spastic or constricted muscles. Botox has yet to be approved by the Food and Drug Administration in this capacity but it is has been approved to treat cervical dystonia or repetitive neck muscle contraction, abnormal twitching of the eyelids, crossed eyes and even severe underarm sweating. The drug has been routinely used to decrease muscle tightness and used to treat cerebral palsy patients with the majority of results being beneficial.

Treating cerebral palsy patients with Botox has yet to be approved by the FDA and is considered an "off label" use of the drug. An "off label" use is not illegal or inappropriate as long as patients are warned about the all the potential side effects of the drug. Doctors who use Botox as a treatment for cerebral palsy see little side effects but some patients are claiming it has taken the lives of their children. In rare cases Botox has been shown to cause muscle paralysis and difficulty breathing especially when injected in the neck area. Two lawsuits have been filed against Botox, its manufacturer and treating physicians for the deaths of two children with cerebral palsy. In both cases, parents claim that after Botox injections their child stopped breathing and was unable to be resuscitated.

It is always important to fully discuss all treatment options with your physician especially when a drug is being used "off label." No one in the medical community doubts the benefits of Botox but doctors and patients must be aware of the rare but dangerous side effects.

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