Placental insufficiency is a serious medical condition that affects pregnancy, potentially endangering both the mother and the unborn child. It occurs when the placenta, a vital organ responsible for delivering nutrients and oxygen to the fetus, fails to function adequately.
Failure by medical professionals to detect and address placental insufficiency, which can harm the baby, constitutes medical malpractice. In this article, we will explore the causes and symptoms of placental insufficiency and the importance of early diagnosis and treatment.
We will also investigate medical negligence cases in which failing to recognize and treat placental insufficiency seriously impacts maternal and fetal health.
Understanding Placental Insufficiency
The placenta, a vital organ connecting the mother and fetus, requires substantial energy and oxygen to support fetal development. Placental insufficiency occurs when oxygen and nutrients are inadequately transferred to the fetus during pregnancy due to compromised placental vascular remodelling.
The deterioration in placental functioning disrupts blood flow, leading to fetal hypoxemia and growth restriction. Placental insufficiency may manifest through various symptoms, including:
- Low amniotic fluid levels: Inadequate amniotic fluid levels can be associated with placental dysfunction.
- Decreased fetal movement: A decrease in the baby’s movements could indicate that the fetus is not receiving enough oxygen and nutrients due to placental insufficiency.
- Maternal symptoms: In some cases, the mother may experience symptoms such as persistent abdominal pain, vaginal bleeding, or fluid leakage.
Factors Increasing the Risk of Placental Insufficiency
The risk of placental insufficiency can be heightened by various medical conditions and risk factors, including the following:
- Diabetes
- Pre-eclampsia
- Blood-clotting conditions
- Fetal infections
- Smoking, alcohol consumption, or the use of illegal or recreational drugs
- High blood pressure, kidney problems, or heart disease
- Previous complications in the current pregnancy, especially heavy bleeding
- Advanced maternal age (older than 40 years)
- History of a small baby, pre-eclampsia, or stillbirth in previous pregnancies
Diagnostic Tools for Placental Insufficiency
Proper prenatal care is crucial for early detection of placental insufficiency, improving outcomes for both mother and baby. Diagnostic tests include:
- Fetal ultrasound: Monitors fetal growth.
- Pregnancy ultrasound: Measures placental size.
- Fetal non-stress test (NST): Evaluates fetal well-being.
- Alpha-fetoprotein (AFP) levels: Assesses placental function.
Early diagnosis allows for timely interventions and management strategies to optimize outcomes.
Treatment of Placental Insufficiency
Management of placental insufficiency depends on the timing of diagnosis during pregnancy. When identified before the fetus is viable (less than 24 weeks), women can expect:
- Coordinated care involving their referring obstetrician, family doctor, or midwife and a specialized clinic, facilitating a smooth transfer of care as needed.
- Education on preeclampsia for self-monitoring blood pressure at home, preventing a late diagnosis that may lead to early birth and pose risks to both mother and fetus.
- A plan for fetal monitoring using ultrasound to recognize and carefully monitor fetal growth restriction (FGR). This plan is integrated with regular visits for standard prenatal care.
If diagnosed after the fetus is viable (more than 24 weeks), the disease may either remain subclinical or present with issues such as excess maternal weight gain, leg swelling, headaches (signs of preeclampsia), a small stomach or reduced fetal movement (signs of FGR), lack of fetal movement and heartbeat for two days (signs of stillbirth), or vaginal bleeding and/or contractions (signs of preterm labour with placental complications).
If any of the conditions mentioned above are observed, the following steps will be taken:
- Increased clinic visit frequency for preeclampsia or FGR, progressing to weekly, twice a week, and ultimately hospital admission for daily monitoring.
- In case of concerns about the need for delivery before 32 weeks, the mother may be offered a course of steroids (2 intramuscular [thigh] injections) to strengthen the developing lungs and prepare for an early birth.
- If preeclampsia and/or FGR are severe and likely to require delivery before 32 weeks, a high-risk obstetrician or maternal-fetal medicine (MFM) specialist takes over for intensive outpatient or inpatient care.
Medical Malpractice and Placental Insufficiency
Medical negligence may be a factor in cases of placental insufficiency when healthcare professionals fail to meet the standard of care expected in managing pregnancy and related conditions.
Here are some instances where medical negligence may contribute to placental insufficiency:
- Failure to conduct necessary tests to diagnose placental insufficiency promptly.
- Neglecting to properly assess a mother’s concerns, such as changes in fetal movements or abnormal abdominal size.
- Failing to refer the mother to a specialist in high-risk fetal care for further evaluation and management.
- Not performing a Cesarean section when it is both safe and medically indicated for the well-being of the baby.
- Neglecting to prescribe appropriate treatments, such as bed rest, to help manage placental insufficiency and reduce associated risks.
- Failure to monitor the mother for further potential complications such as preeclampsia, which can worsen the effects of placental insufficiency on both mother and baby.
The Consequences of Undiagnosed Placental Insufficiency
The effects of placental insufficiency on the developing baby are quite complicated and can involve various factors. The primary effects typically include placental respiratory failure and fetal hypoxemia, both contributing to intrauterine growth restriction and its associated consequences, such as prematurity.
The most severe complication is the complete absence of proper placentation, leading to miscarriage. For the developing fetus, the extent of umbilical artery abnormalities observed through Doppler is linked to:
- Acidosis
- Resuscitation needs
- Pressor support
- Ventilatory support
- Multisystem organ failure
This often occurs when hypoxemia triggers a redistribution of blood flow in the fetus, prioritizing essential organs like the brain and heart at the expense of other vital organs, such as the bowels and kidneys.
As placental resistance increases during pregnancy, the already compromised intrauterine growth-restricted (IUGR) fetus faces heightened risks, including:
- Hypoglycemia
- Hypoxic-ischemic encephalopathy
- Thrombocytopenia
- Leukopenia
- Anemia
Moreover, there is evidence suggesting that infants affected by placental insufficiency may be susceptible to cognitive deficits during childhood and could potentially develop chronic illnesses in adulthood.
Beyond the immediate medical concerns, here are some effects that victims and their families may endure:
- Medical expenses: The management of placental insufficiency often involves intensive medical care, frequent monitoring, and potential interventions. This can lead to substantial medical expenses, placing an added financial burden on the affected families.
- Emotional trauma: The experience of a stillbirth or the birth of a severely compromised infant can have lasting psychological effects on parents and family members, leading to grief, depression, and anxiety.
Legal Recourse
Victims of medical malpractice resulting from failure to diagnose and treat placental insufficiency may pursue legal recourse to seek compensation for damages incurred.
This may include medical expenses, lost income, emotional distress, and long-term repercussions like disability or wrongful death. To successfully navigate the complex legal system, it is vital to seek the experience of a medical malpractice lawyer.
Contact a Medical Malpractice Lawyer at Sommers Roth & Elmaleh Today
If your baby was born with a birth injury in connection with placental insufficiency or a related complication, Sommers Roth & Elmaleh can help you seek compensation from the responsible parties.
Contact the medical malpractice lawyers at Sommers Roth & Elmaleh for a free case assessment. Call us at 1-844-777-7372 or contact us online.