Cord Blood Gases in Birth Injury Cases: A Misunderstood Marker

During labor and delivery, obstetricians (OB/GYNs) often order umbilical cord blood gas testing to assess a newborn’s wellbeing and acid-base status at birth. While cord blood gas results can provide insight into a baby’s condition, defense experts in birth injury lawsuits often wrongly argue that normal values completely rule out hypoxic-ischemic encephalopathy (HIE), brain injuries, and other neurologic injuries.

If your child has suffered brain damage and you’re being told their cord blood gases were normal, do not accept this at face value - there is much more to the story. We’ve written previously about the role of cord blood gas studies in proving birth-related brain injuries.

What are umbilical cord blood gases?

Cord blood refers to the blood within the umbilical cord and placenta at the time of birth. Cord blood gas analysis measures the acid-base balance and oxygen levels in this blood to evaluate fetal oxygenation. We’ve written previously about the role of cord blood gases in birth injury and medical malpractice cases.

OB/GYNs typically obtain samples from both the artery and vein for the most complete assessment. The arterial cord blood gas values provide more information about the fetal (baby’s) state, while venous cord blood gas values reflect placental function and uterine conditions.

Parameters measured in cord blood gas testing

  • pH - measures acidity or alkalinity
  • pCO2 - partial pressure of carbon dioxide
  • pO2 - partial pressure of oxygen
  • Base deficit/excess - reflects metabolic acidosis

In general, a pH of less than 7.0 or a base deficit of 12-16 mmol/L or higher suggests metabolic acidosis and is often a sign of a poor outcome for the baby. As with all tests, though, doctors and parents should look at the full clinical context of the baby.

Limitations of cord blood gas interpretation

While cord blood gases provide a snapshot of the baby’s status at the moment of delivery, they have several significant limitations:

1. Cord gases do not reflect the duration or severity of fetal distress during labor - only the end result. 2. Cord gases can be normal even when a baby experienced an acute near-total hypoxic event (lack of oxygen) shortly before birth. 3. Cord gases may be artificially improved if the baby received aggressive resuscitation and ventilation after delivery, but before the blood sample is drawn. 4. There is no precise pH or base deficit threshold where HIE, brain injury, or neurologic injury is certain to occur. 5. Cord gas values do not predict long-term neurologic outcomes.

ACOG emphasizes limited predictive value

The American College of Obstetricians and Gynecologists (ACOG) has repeatedly stressed that cord blood gases alone do not predict neonatal brain injury. In a 2006 Committee Opinion, ACOG stated: “Umbilical cord blood gas analysis alone is not a predictor of subsequent neurologic outcome.”

A 2014 ACOG technical bulletin on fetal heart rate monitoring also notes “cord blood gases alone are not sensitive or specific to predict brain damage.”

In my experience as a Texas medical malpractice and birth injury lawyer, defense experts like to have it both ways when it comes to ACOG opinions. Despite ACOG’s clear statements, defense experts in birth injury cases often point to normal cord gases as definitive proof that labor and delivery medical malpractice did not occur. Plaintiff attorneys must be prepared to refute this through cross-examination and competing expert testimony.

Proving Birth Injury Malpractice in Texas

In Texas, plaintiffs alleging birth injury malpractice must prove that:

1. A doctor-patient relationship existed; 2. The care provided fell below the accepted standard of care; and 3. The substandard care proximately caused the baby’s injuries.

Cord blood gas evidence may relate to the causation element, but even when the numbers appear normal, it doesn’t necessarily mean there’s no case. Other relevant evidence includes fetal heart rate monitor strips, maternal risk factors, the labor and delivery course, neonatal test results, diagnostic imaging, and the child’s ongoing impairments.

An important timing consideration in Texas birth injury cases is that civil claims must be filed before the child’s 14th birthday, with some limited exceptions. However, the substantial damages that accrue before the child turns 18, such as medical expenses, belong to the parents and are subject to the standard 2-year statute of limitations for medical malpractice cases.

Therefore, it’s critical for parents who suspect birth injury malpractice to consult an attorney as soon as possible to preserve their claims. If a case is not timely pursued, the parents’ right to recover pre-age 18 damages may be lost.

Damages in Texas Birth Injury Lawsuits

When an infant suffers permanent disability due to malpractice, the economic damages alone can be substantial. Through a birth injury lawsuit, plaintiffs can seek recovery for:

  • Past medical expenses to treat the child’s birth injuries
  • Anticipated future medical care through a “life care plan”
  • Therapy, counseling and accommodations for disabilities
  • Past and future pain, suffering and mental anguish of the child and parents

For children with profound impairments like cerebral palsy, the life care plan damages - medical care and support the child will need for their entire lifetime - can reach eight figures. Non-economic damages, such as mental anguish and pain and suffering, though, are capped at $250,000 for all doctors combines and $250,000 for the hospital in Texas medical malpractice cases.

Speak to a Texas Birth Injury Attorney

Cord blood gases are just one piece of the birth injury puzzle. While they can provide clues, they should never be relied upon in isolation to rule out malpractice. If your child has been diagnosed with HIE, cerebral palsy, or a brain injury and you believe the labor and delivery care was questionable, speak to a knowledgeable Texas birth injury medical malpractice attorney right away. Read our article about how to pick the right Texas attorney for your HIE or birth injury medical malpractice case.

The consultation is free and can help you understand your family’s legal rights and options. With experienced counsel by your side, you may be able to recover substantial compensation for the tremendous burdens of birth injury while also holding negligent providers accountable. But do not delay - the sooner you act, the better your chances of obtaining justice.

Robert Painter
Article by

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.