Prenatal care, testing, and medical malpractice

One of the most important things to do after having a positive pregnancy test, or even suspecting that you might be expecting a baby, is to schedule a prenatal appointment. Although there are various prenatal options for expectant moms, in my experience as a Houston, Texas medical malpractice lawyer, seeking care from a board certified OB/GYN is the safest choice.

Seeking early prenatal care is important because it establishes a baseline for the development of the baby, and increases the safety of both the baby and mother. After the doctor confirms pregnancy with an office-based test, the standard of care requires an extensive series of workups, assessments, and tests to be performed throughout the course the pregnancy.

Some tests and evaluations are fetal/baby-focused and others are mother-focused.

Fetal/baby prenatal testing

In the first trimester, there are typically three types of screening tests for the baby. The first is an ultrasound test for nuchal translucency, which looks at the back of the baby’s neck for increased fluid or thickening. The other two tests are bloodwork for pregnancy-associated plasma protein screening and human chorionic gonadotropin (hCG). Abnormal levels in these can indicate a genetic or chromosomal abnormality, including a birth defect, Down syndrome (trisomy 21) and trisomy 18.

A first-trimester ultrasound is done to estimate the baby’s due date and verify normal development of expected parts of the body.

Second trimester prenatal testing of the baby also focuses on potential genetic conditions. The first test, alpha-fetal protein screening (AFP), looks for abnormal levels that could indicate open neural tube defects (ONTD) like spina bifida, Down syndrome, or other chromosomal abnormalities. In addition, AFP may also alert the doctor of a miscalculated due date for the baby, or even the presence of twins. Other testing in the second trimester includes bloodwork for hCG, estriol, and inhibin.

Abnormal results may indicate the need for further studies, that could include amniocentesis, chorionic villus sampling (CVS), and ultrasound studies.

Around 18-20 weeks into the pregnancy, a second ultrasound is done to confirm the due date, verify the number of babies in the pregnancy, and check for normal development of the baby.

Experts have explained that having these tests done in both the first and second trimesters provide more reliable information about any potential illnesses or conditions of the baby that might be indicated by testing.

In the third trimester, an OB/GYN may order electronic fetal monitoring or a non-stress test to assess the baby’s heart rate and overall condition. In addition, a third-trimester ultrasound is done to monitor the baby’s growth and as part of the biophysical profile to check the baby’s overall development and well-being.

Maternal prenatal testing

In addition to the testing done during the prenatal period on babies, the standard of care recommends assessments and evaluations of the mother.

During the first trimester, important bloodwork should be drawn and analyzed to determine the mother’s blood type and Rh status. Mothers with Rh-negative blood require special attention and workup, to ensure that their blood is not incompatible with her baby. First trimester bloodwork looks for Rh incompatibility and, if it is present, the mother and baby are followed closely throughout the pregnancy, to ensure appropriate treatment to prevent the mother’s immune system from attacking the baby’s red blood cells, potentially causing brain damage.

Other mother-focused testing during the prenatal period includes bloodwork to assess gestational diabetes and Group B strep. Group B Streptococcus bacteria are found in the lower genital tract of about 25% of all women, and require additional treatment to avoid harm to the baby during delivery.

Weight issues during pregnancy

One of the issues expected in every pregnancy is a change in the mother’s weight. Recent medical research, published online by the Journal of the American Medical Association (JAMA), in November 2017, looked into the relation between body mass index (BMI) and the risk of pregnancy-related complications and death.

Maternal -related pregnancy complications include diabetes, pre-eclampsia, cesarean delivery, sepsis, shock, cardiovascular events, cerebrovascular events, and acute renal (kidney) failure.

The risks to the baby include preterm birth, macrosomia, fetal growth restriction, and stillbirth.

The study concluded that low and high pre-pregnancy BMIs increase a mother’s risk for severe pregnancy -related complications and death.

This new research provides another reason why expectant mothers should be quick and vigilant about receiving quality prenatal care.

Prenatal care concerns

In my experience as a Houston, Texas medical malpractice lawyer, I have found that some OB/GYN office practices are run more like conveyor belts than clinics where individualized care is provided. This seems particularly true at larger practices, where a patient may be seen by multiple doctors over the course of the prenatal care.

I believe that the cause of this problem is that the doctors and healthcare providers are busy seeing many patients go in and out of their offices each day. All the patients are pregnant and going through similar prenatal testing and assessments, which means it can be easy for things to fall through the cracks.

You can help increase the safety for yourself and your baby by being actively engaged in the process, rather than being a passive patient.

I recommend that all expectant mothers keep a pregnancy journal, beginning with the verification of pregnancy and going all the way up to the delivery of the baby. Record in the journal how you feel, any complications or illnesses you have, any medications you have to take, as well as any conversations you have with your prenatal care providers, including any tests that are ordered.

At each prenatal appointment, talk with your doctor about what tests are being ordered and why, and then ask for the results at your next appointment.

I am working on a case now where a Houston-area mother was seen by four separate OB/GYN physicians in the same office during the course of her pregnancy. Some of the basic bloodwork required by the standard of care was never done because it fell through the cracks and none of the doctors noticed it during the pregnancy. Sadly, this caused her baby to be born with a brain injury, which would likely have been entirely avoided with proper prenatal care by the doctors.

We are here to help

If you or a loved one has a baby who has been seriously injured as a result of prenatal, hospital, or medical malpractice, call Painter Law Firm’s experienced medical malpractice attorneys at 281-580-8800, for a free consultation about your potential case.


Robert Painter is an attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical malpractice and wrongful death lawsuits against hospitals, doctors, surgeons, pharmacies, and other healthcare providers.

Robert Painter
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Robert Painter

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm Medical Malpractice Attorneys 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 for a free consultation and strategy session by calling 281-580-8800 or emailing him right now.