Abstract
Cerebral palsy litigation cases account for the highest claims involving obstetricians/gynecologists, a specialty that ranks among the highest liability medical professions. Although epidemiologic studies indicate that only a small proportion of cerebral palsy (10–20%) is due to birth asphyxia, negligent obstetrical care is often alleged to be the etiologic factor, resulting in contentious medical-legal conflicts. Defense and plaintiff expert opinions regarding the etiology and timing of injury are often polarized, as there is a lack of established methodology for analysis. The objective results provided by umbilical cord and newborn acid/base and blood gas values and the established association with the incidence of cerebral palsy provide a basis for the forensic assessment of both the mechanism and timing of fetal neurologic injury. Using established physiologic and biochemical principles, a series of case examples demonstrates how an unbiased expert assessment can aid in both conflict resolution and opportunities for clinical education.
Highlights
Whether the result of an occurrence during prenatal development or consequence of labor or the postnatal period, cerebral palsy is a devastating outcome
As greater numbers of adults survive with cerebral palsy, the prevalence of high-burden medical conditions and healthcare resource utilization has markedly increased [3,4]
Epidemiologic studies indicate that only a small proportion of cerebral palsy (10–20%) is due to birth asphyxia [7], negligent obstetrical care is often alleged to be the etiologic factor
Summary
Whether the result of an occurrence during prenatal development or consequence of labor or the postnatal period, cerebral palsy is a devastating outcome. Despite the clinical incorporation of electronic fetal monitoring, the rates of cerebral palsy have not changed significantly since the early 1970s, averaging 2 per 1000 live births [1] Among those born with mild impairment, survival duration does not differ significantly from that of the population; mortality increases, as expected, with increasing severity of impairment. The objective nature of umbilical cord and newborn blood values and the established association with the incidence of cerebral palsy can provide a basis for the forensic assessment of both the mechanism and timing of the neurologic injury. This paper will examine a series of obstetric cases to illustrate the forensic process by which cord blood gas analyses can contribute to the determination of the timing and causation of a fetal injury.
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