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Intrauterine Growth Restriction and Cerebral Palsy


    In this third blog in our series relating to injuries suffered around the time of birth, we will be considering the implications of intra-uterine growth restriction (IUGR).

    By Kerstin Kubiak

IUGR is a condition where a baby’s growth velocity slows down, or in some cases stops, during pregnancy leading to the baby having a low weight on birth, approximately in the lowest 10% of babies born at that same stage in pregnancy.

Concern of IUGR arises when a baby’s growth, which may have started normally, then slows and falls below the expected pattern which implies an underlying problem, such as placental insufficiency – the placenta being responsible for supplying the baby with essential oxygen and nutrients during pregnancy.

How is IUGR diagnosed and what are the potential complications if a baby is growth restricted?

If a baby is growth restricted then they can sometimes suffer complications including: deprivation of oxygen during labour which can lead to brain damage; neonatal problems such as low blood sugar and/or jaundice; and tragically stillbirth or early death following their birth.

IUGR is usually suspected during pregnancy as a result of regular measuring of the pregnancy bump which is then plotted on a graph – if the growth is low or appears not to be following the expected path then further investigations can be carried out, including ultrasound scans and careful monitoring of the baby’s wellbeing.

If IUGR is diagnosed during pregnancy then there are steps that can be taken to try to reduce the possibility of complications occurring which can affect the baby’s wellbeing, these include careful and regular monitoring of the baby’s wellbeing and, if there are concerns, early delivery by caesarean section.

If appropriate care is not taken during pregnancy either in respect of monitoring the baby’s growth and diagnosing IUGR; or, once IUGR has been diagnosed, failing to then take appropriate steps to ensure the baby’s safe delivery, and the baby suffers brain injury as a result then this could give rise to a clinical negligence claim.

Case report – failure to diagnose IUGR during pregnancy causing cerebral palsy

We acted for a young girl who sadly suffered injury to her brain around the time of her birth as a result of the failure to diagnose that she was growth restricted during pregnancy.  Her mother’s pregnancy had seemed to progress without problem and she went into spontaneous labour 2 days past her due date.  Upon admission to hospital monitoring of the baby’s heart rate was started and was immediately concerning as to the baby’s condition, and a decision was made for an emergency caesarean section.  Our client was born in very poor condition, weighing just under 4lb.  She was transferred to the neonatal intensive care unit and diagnosed with severe IUGR.  Sadly, early scans revealed damage to our client’s brain and she was subsequently diagnosed with cerebral palsy, and requires 24 hour care and support for all her needs.

It was alleged that the midwives caring for our client’s mother negligently failed to diagnose that our client was growth restricted during pregnancy.

There was careful consideration of the measurements which were recorded by the midwives caring for our client’s mother at various points during her pregnancy and it was noted that there were several occasions where the growth was noted to be lower than expected for the stage of pregnancy and therefore missed opportunities for further investigations which would likely have confirmed that our client was growth restricted by about 37 weeks in to the pregnancy.  There were also failures to note that there was reduced amniotic fluid.

Had IUGR been diagnosed then our client’s case was that her mother would have been referred to an obstetrician for further advice, which in turn would likely have led to delivery of our client by planned caesarean section before the Claimant’s mother went into labour, and probably by 39 weeks into the pregnancy.

As a result of these failures our client suffered from increasing placental insufficiency for the last weeks of her mother’s pregnancy and this, in turn, left her unable to cope with the demands of labour, even for a short time, and she suffered injury to her brain and cerebral palsy due to oxygen deprivation.  Had she been delivered by earlier caesarean section then she would have avoided the injury to her brain caused by oxygen deprivation during labour.

The Defendant denied that they had failed to diagnose IUGR and argued that the measurements carried out were always normal and had not required any further investigations.  Our client’s case continued to be argued and the Defendant ultimately paid our client significant financial compensation for her injuries.

The next blog in our series will look at other causes of oxygen deprivation and how this can cause injury to a developing baby’s brain, the monitoring undertaken during delivery and when failures in care may give rise to a claim.

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