Fever during labor and delivery as a cause of brain injuryMaternal fever can cause hypoxic-ischemic encephalopathy birth injury
We’re working on a sad case involving a baby who was born with hypoxic-ischemic encephalopathy (HIE)—a profound brain injury—at a major hospital in Houston’s Texas Medical Center. Let’s call the baby Ben and his mother Betty.
This was Betty’s first pregnancy and at 38 weeks gestation, she was at full term. When she felt a rush of fluid, she immediately called her obstetrician (OB), who told her to go to the hospital. Her OB physician admitted Betty to the labor and delivery unit and ordered augmentation of labor with Pitocin, to get uterine contractions underway.
Betty was in labor for over 20 hours before Ben was delivered vaginally. His initial Apgar scores were low, which is a sign of a problem. A pediatrician assessed Ben, and noted that he was born apneic (not breathing) and limp.
The medical team ordering an MRI of Ben’s brain, which was scanned around two days after he was born. It showed the characteristic injury to the watershed region of the brain that’s common in case of HIE where the baby didn’t get enough oxygen around the time of delivery.
When we investigate potential birth injury cases, the first place we look in the medical record is the electronic fetal monitoring strip. In conjunction with obstetrical physician and labor and delivery nursing experts, we examine the strip for a lack of variability, lack of accelerations, and presence of concerning decelerations. These can be signs of an acidotic environment that is harmful to a fetus, requiring emergency delivery by C-Section.
In Ben’s case, though, the fetal monitoring strip didn’t show any signs of problems that should’ve signaled acidosis or the need for an emergency delivery.
But our investigation didn’t end there. In speaking with a board-certified obstetrical experts, we learned about another concerning issue that can independently cause fetal hypoxia and HIE.
Intrapartum fever (pyrexia)
Betty’s labor and delivery records show that she had a fever for almost 10 hours before Ben was delivered.
Women, like Betty, who had never delivered a baby before (healthcare providers describe this as “nulliparous”) have an increased risk of an intrapartum fever. So do women who have prolonged labor.
The medical literature also shows that women who receive epidural anesthesia have an increased risk of developing fever. In fact, many studies suggest that epidurals cause more intrapartum fevers than infections, such as chorioamnionitis.
Regardless of the cause of a fever, our labor and delivery nursing expert explained that the standard of care requires nursing staff to notify a physician. These fevers need promptly treated because they’ve been linked to causing encephalopathy (brain injury) in the newborn.
Our obstetrical expert explained that the standard of care requires considering the cause of the fever to be an infection until proven otherwise. Therefore, standard orders would include antibiotics, as well as a medication like Tylenol to lower the fever.
Sadly, Ben’s permanent birth-related brain injury was avoidable.
Our experts believe that the labor and delivery nursing staff kept Betty’s OB physician in the dark about her infection for almost 10 hours before Ben’s delivery. As a result, there were no orders to control her fever. This created an environment that primed the baby for a hypoxic birth injury.
Birth injury medical malpractice cases can be challenging to investigate. If your baby or a loved one has suffered from a birth-related brain injury in Texas, it’s important to contact an experienced, top-rated Texas medical malpractice attorney for a free strategy session about your potential case.
Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him by calling 281-580-8800 or emailing him right now.
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