Medical Malpractice
Our law firm handles birth injury cases in Maryland and throughout the United States. We spend a lot of time reading through medical records in birth injury claims. Whether you are a parent or a lawyer trying to understand the mother and child’s medical records, you will see quickly this area of medicine has its own argot. Below are some (mostly) easy to understand explanation of common terms our lawyers see in birth injury litigation.
Alkalosis – abnormal lack of hydrogen ion in the tissue. This leads to a lower PH blood level.
Anemia – in a newborn, anemia is defined as central venous hemoglobin of < 13 g/dL or capillary hemoglobin < 14.5 g/dL.
Anoxia – lack of oxygen within the tissues
Apgar – first test after childbirth to evaluate the baby’s health. Apgar is a rating system on a scale of one to ten that evaluates: (1) skin color; (2) heart rate; (3) reflexes; (4) muscle tone; and (5) breathing.
Asphyxia – simultaneous occurrence of too much carbon dioxide in the blood and too little oxygen in the blood. So it is asphyxia plus metabolic acidosis. A child with birth asphyxia will typically have a lower than optimal PH blood levels at birth and low Apgar case.
Brachial plexus injury – the stretching of the nerves of the brachial plexus beyond their elastic limit
Bradycardia – when the heart rate is below 100 bpm for a fetus (term and post-term) or less than 120 bpm (pre-term)
Breech birth – baby is delivered bottom first instead of head first. There are three types of breech births: (1) Frank – buttocks down but legs are stretched up to the head; (2) complete – the buttocks are down and the baby’s legs are folded in front of the body; and (3) incomplete – one or both legs down so that the feet fall into the birthing canal during delivery.
Cardiotocography – the monitoring of the fetal heart rate and uterine activity during the birthing processes. Also spelled cardiotokography by some health care providers
Cephalic presentation – when the fetus presents head first.
Cerebral palsy – A birth injury caused by oxygen deprivation during childbirth that typically results in limited muscle movement and coordination.
Chorioamnionitis – an infection of the placenta and amniotic fluid.
Cycle – heart rate fluctuation above, though, and back to the average baseline. Also called oscillation, complex, or sine wave.
Deceleration – decrease in the fetal heart rate below the fetal baseline heart rate.
EDD – expected date of delivery
Ecchymosis – leakage of blood into the tissues under the skin because of trauma to the blood vessels
Effacement – shortening or thinning of the cervical canal which typically occurs during the beginning of dilation.
Episodic changes – accelerations or decelerations of the fetal heart rate that are not connected to any uterine activity
Fetal distress – another term used in the medical records that mean multiple things to different obstetricians. In general, fetal distress suggests that the baby is not getting the oxygen it needs and that brain damage can be the result if the distress is not alleviated. It’s a usually marked with deteriorating fetal heart rate that might include late or prolonged decelerations, rising baseline, decreasing variability, or bradycardia.
Fetal lie – the relationship between the fetal body to the mother’s body
Fetal macrosomia – birthweight of greater than 4000 grams or a birthweight greater than 90% for population and gender-specific infant growth curves
Fetal scalp blood sampling – a collection of blood from the fetal scalp to analyze PH blood levels
Fetal monitor tracings (TMT) – the record of the fetus’ heart rate
Fundal pressure – pressure on the abdomen.
Gestation – time from conception to birth
Gestational hypertension – higher blood pressure while pregnant that is above 140/90
Gravida (G) – mother’s number of pregnancies
Hyperstimulation – six or more contractions within a 10-minute period. Doctors describe hyperstimulation as a uterus that doesn’t relax well in between contractions.
Hypoxemia – low blood oxygen levels
Hypoxia – lack of oxygen. This deprivation of oxygen to the tissues can happen on a number of different bases, but it is not enough oxygen is getting to the cells that need it. If the child is anoxic, that means there’s no oxygen. Hypoxic means that there’s a diminished amount of oxygen.
Hypoxic-ischemic – the combination of hypoxia and ischemia where you have diminished amounts of blood flow and diminished amounts of oxygen.
Intrapartum – another way of saying labor and delivery.
Ischemia – poor circulation or perfusion or inadequate blood flow.
Labor – contractions and progressive cervical change.
Lifecare plan – involves data collection, resource development and planning strategies within an interdisciplinary rehabilitation environment. It d
etermines the needs of catastrophically injured individuals and projects the costs of needed services, treatment and equipment over the individual’s life-span
Life expectancy – the expected number of years of remaining life of a person. It can be calculated specific to the individual or it can be the average number of years lived by a group of persons from their starting age until all have died
Long-Term Variability (LTV) – fluctuation range of the heartbeat above and below the baseline. LVT is calculated in one-minute intervals.
Membranes – the sac that surrounds and protects the fetus. There are two chorioamniotic membranes called the amnion and chorion that create the amniotic sac. There are two other fetal membranes called the allantois and the secondary umbilical vesicle.
Meconium – darn green mucilaginous material that resides in the intestine of the fetus.
Microcephaly – abnormally small head circumference usually defined as greater than two standard deviations below the mean for age and sex (<3.2%).
Nadir – lower fetal heart rate reading in a deceleration
Neonatal encephalopathy – is a baby exhibiting abnormal consciousness, tone, reflexes, feeding aspiration or seizures.
Neonatal Shock is defined as inadequate perfusion of the tissues to deliver adequate oxygen and remove toxic waste products from the baby
Nonreassuring heart rate – When abrupt changes in the fetal heart rate become persistent, more progressive, longer lasting or if the fetus has a persistently slow return to the baseline heart rate. This suggests hypoxia which increases the risk of metabolic acidosis
Normal contraction frequency – five contractions or less in ten minutes, averaged over a 30-minute window. Increased uterine contraction frequency, called tachysystole, is defined as more than five contractions in 10 minutes, averaged over a 30-minute window
Oligohydramnios – A a lack of optimal amniotic fluid in the uterine cavity that can set up umbilical cord compression because the fetus’s body is more likely compress the cord between its body and the uterine wall.
Oxytocin challenge test – also called a contraction stress test or a stress test, this test looks for oxygen deprivation from the placenta. The presence of late decelerations associated with the majority of uterine contractions and it suggest the possibility of uteroplacental insufficiency.
Perinatal period – the time period that begins with the onset of fetal viability (about 24 weeks gestation)
Perinatologist – maternal-fetal medicine doctor
Pitocin – a drug used to expedite labor to promote labor. It is a dangerous drug that needs to be used cautiously.
Placental abruption – the separation of the placenta from the uterine wall before childbirth. Vaginal bleeding, bloody amniotic fluid, stomach pain, uterine contractions and tenderness, and fetal heart rate abnormalities are warning signs of a placental abruption.
Placenta previa – implantation of the placenta over the small hole at the center of the cervix. There are three recognized variations: complete, partial and marginal. With complete placenta previa, the cervical os is completely covered by the placenta. Marginal placenta previa is where the placenta is embedded very near to the cervical os.
Preeclampsia – high blood pressure at or greater than 140/90 seen with protein in the urine greater than 300 mg over a 24 hour period (or consistent positive results on a protein dipstick).
Profusion pressure of the brain – mean arterial pressure minus venous pressure. Any increase in venous pressure subtracts from the arterial pressure and further reduces profusion. This can result in ischemic injury.
Reactivity – a vague term with many different meanings that we often see in medical records in birth injury cases that relate to heart rate accelerations
Sepsis – in the newborn period, sepsis is defined as a positive blood culture for a pathogenic organism.
Shoulder dystocia – when the anterior shoulder impinges on the pubic symphysis blocking the child’s head from clearing during childbirth. In other words, the baby’s shoulder cannot fit through the mother’s birth canal.
Tachycardia – sustained elevation of the fetal heart rate. This is an indication the baby is in distress
Tachysystole – mother experiences more than five contractions in a ten minute period, averaged over thirty minutes.
Term – any time after 37 completed weeks of gestation and up until 42 completed weeks of gestation (260 to 294 days).
Thrombocytopenia – a platelet count less than 150,000, although a few normal neonates may have platelet counts as low as 100,000 in the absence of clinical disease.
Tocolytic – a drug that slows or stops uterine activity
Tonus – the intensity of uterine tone or intrauterine pressure between uterine contractions
Variability – the variation in the time interval between heartbeats. On the fetal monitoring strips, it is the “waviness” of the tracings. Generally, variability is a good thing that should not be confused with variable decelerations which are a sign that baby may be, or may soon be, in distress.
Variable decelerations – Variable decelerations are considered non-reassuring only when they become persistent, progressively deeper, and longer lasting, or if they have a persistently slow return to baseline.
Vasa previa – blood vessels in the placenta and the umbilical cord become trapped between the presenting part of the fetus and hole
in the center of the cervix.
Vasospasm – hemorrhage within the brain that produces as a result spasm of arterial supply that profuses the brain and reduces the profusion of the brain.
Getting a Birth Injury Lawyer
Our birth injury lawyers are based in Baltimore, Maryland. We handle birth injury claims all of the United States. We hire a lawyer in your jurisdiction to assist us that comes out of our attorneys’ fee. You get two law firms for the price of one. Call us today at 800-553-8082 or get a free online consultation. There is never a fee or cost associated with your case unless you get a financial recovery.
More Resources
- The settlement value of birth injury cases
- Many birth injury cases are delayed or failure to perform C-section claims