Failure to Monitor Maternal Conditions During Pregnancy

Pregnancy requires regular monitoring because a mother’s health can change significantly as the pregnancy progresses. Conditions that develop during pregnancy, or even some that existed before conception, can affect both the mother and the developing baby. When these conditions are not identified, monitored, or appropriately managed, the consequences can include premature birth, oxygen deprivation, fetal growth problems, birth trauma, brain injury, and other serious complications.

Some maternal conditions are difficult to predict or prevent, and complications can occur even when appropriate medical care is provided. However, obstetric providers have a responsibility to monitor known risk factors, recognize warning signs, order appropriate testing, and respond when a mother’s condition or the baby’s well-being changes. When a failure to do so causes preventable harm, the family may have grounds for a medical malpractice claim.

The California medical malpractice attorneys at Kalfayan Merjanian, LLP represent families dealing with the devastating consequences of birth injuries. Understanding how maternal conditions can affect a pregnancy is an important first step in determining whether appropriate prenatal care was provided.

Prenatal Monitoring Can Identify Developing Risks

Prenatal care is not simply a series of routine appointments. Each visit provides an opportunity to evaluate the mother’s health, assess the baby’s development, identify emerging risk factors, and determine whether additional testing or treatment is necessary.

Depending on the circumstances, prenatal monitoring can include blood pressure measurements, blood and urine testing, glucose screening, ultrasound examinations, fetal growth assessments, fetal heart-rate monitoring, and other forms of antenatal surveillance. The appropriate monitoring depends on the mother’s medical history, gestational age, symptoms, test results, and other risk factors.

For example, the American College of Obstetricians and Gynecologists (ACOG) recommends that blood pressure be checked at every prenatal visit. Women with hypertension or preeclampsia may require additional monitoring of maternal health and fetal growth, while certain high-risk pregnancies may require antenatal fetal surveillance.

A failure to perform appropriate monitoring can allow a condition to progress without detection. By the time the problem becomes obvious, the mother or baby may already be experiencing serious complications.

Preeclampsia and Pregnancy-Related Hypertension

Preeclampsia is one of the most important maternal conditions that requires careful monitoring during pregnancy. It generally develops after 20 weeks of pregnancy and involves high blood pressure along with other signs of organ involvement. In severe cases, it can threaten the health of both the mother and fetus.

Preeclampsia can affect blood flow to the placenta, potentially limiting the oxygen and nutrients available to the fetus. It is also associated with complications such as fetal growth restriction and preterm birth. ACOG notes that severe or uncontrolled hypertension during pregnancy can cause serious problems for the mother and fetus.

Monitoring may include repeated blood pressure measurements, urine testing, blood tests evaluating kidney and liver function and platelet levels, assessment of fetal growth, and fetal surveillance when appropriate. If preeclampsia worsens or the fetus is showing signs of distress, delivery may become necessary.

A failure to recognize progressively elevated blood pressure, investigate symptoms such as severe headaches or vision changes, or respond appropriately to abnormal test results can potentially allow a dangerous condition to progress. In a birth injury case, medical experts may examine whether earlier recognition or intervention would likely have changed the outcome.

Gestational Diabetes and Excessive Fetal Growth

Gestational diabetes can also create risks for both mother and baby. Because elevated maternal blood glucose can affect fetal growth, an undiagnosed or inadequately controlled case of gestational diabetes may contribute to complications later in pregnancy and during delivery.

ACOG recommends screening pregnant women for gestational diabetes, with testing generally performed between 24 and 28 weeks when earlier testing is not indicated by risk factors or medical history. Women diagnosed with gestational diabetes generally require additional prenatal care to monitor both maternal and fetal health.

One concern is excessive fetal growth, sometimes referred to as fetal macrosomia. Larger babies have an increased risk of labor abnormalities, shoulder dystocia, and birth trauma.

This does not mean that a large baby automatically indicates negligent care. Estimating fetal weight before birth has limitations, and decisions about delivery must account for the individual circumstances of the pregnancy. ACOG specifically recognizes that third-trimester ultrasound estimates of fetal weight are imprecise.

However, when significant risk factors are present, medical records may need to be examined to determine whether the pregnancy was appropriately monitored and whether the medical team responded reasonably to the information available at the time.

Cephalopelvic Disproportion and Difficult Labor

Cephalopelvic disproportion, or CPD, occurs when the baby’s size or position and the mother’s pelvis make vaginal delivery difficult or impossible. The condition may become apparent only as labor progresses, rather than being conclusively diagnosed during an earlier prenatal appointment.

CPD can be particularly important when combined with other risk factors, including suspected fetal macrosomia. A prolonged or obstructed labor may increase the risk of fetal distress and other complications.

The medical team may need to evaluate fetal size, fetal position, the mother’s pelvic anatomy, the progress of labor, cervical dilation, fetal descent, and fetal heart-rate patterns. When labor is not progressing normally, continued attempts at vaginal delivery may not always be appropriate.

The question in a potential malpractice case is therefore not simply whether CPD existed. It is whether the medical team recognized relevant risk factors, appropriately monitored the progression of labor, recognized signs that vaginal delivery was becoming unsafe, and intervened when necessary.

Other Maternal Conditions That May Require Additional Monitoring

Preeclampsia and gestational diabetes are not the only maternal conditions that can affect pregnancy outcomes. Depending on the circumstances, prenatal care may also need to account for chronic hypertension, diabetes that existed before pregnancy, kidney disease, autoimmune disorders, thyroid disorders, certain infections, anemia, obesity, multiple gestation, and other maternal or pregnancy-related risk factors.

For example, chronic hypertension can increase the risks of preeclampsia, preterm birth, placental abruption, fetal growth problems, and cesarean delivery. ACOG notes that women with chronic hypertension may require blood pressure monitoring, assessment for preeclampsia, and additional testing to evaluate fetal growth and well-being.

The presence of a maternal medical condition does not by itself mean that malpractice occurred. What matters is whether the condition was appropriately identified and managed based on the circumstances of the pregnancy.

How Failure to Monitor Can Lead to Birth Injury

Maternal conditions can affect a baby in different ways. Some create risks gradually during pregnancy, while others can cause an acute emergency.

A failure to identify or manage a maternal condition may contribute to:

• Fetal growth restriction or excessive fetal growth
• Preterm birth
• Placental complications
• Fetal oxygen deprivation
• Fetal distress
• Shoulder dystocia and birth trauma
• Brain injury caused by oxygen deprivation
• Nerve injuries, including brachial plexus injuries
• Respiratory complications associated with premature delivery

The connection between a maternal condition and a birth injury is not always straightforward. A medical malpractice case generally requires more than demonstrating that the mother had a medical condition and the baby was injured. The evidence must establish that the care provided fell below the applicable standard and that the failure was a cause of the injury.

Warning Signs and Missed Opportunities

One of the most important issues in a prenatal negligence case can be whether there were warning signs that should have prompted additional evaluation or intervention.

For example, repeated abnormal blood pressure readings may warrant further evaluation for hypertensive disorders. Abnormal glucose testing may require follow-up and management. Evidence of abnormal fetal growth may lead to additional assessment. Reduced fetal movement, concerning symptoms, abnormal laboratory results, or changes in fetal testing can also require an appropriate response.

In some cases, the problem is not that a condition was never diagnosed. Instead, the medical team may have recognized the condition but failed to monitor it adequately or failed to respond when the mother’s or baby’s condition deteriorated.

ACOG’s guidance on antenatal fetal surveillance illustrates how monitoring can change based on pregnancy risks. For example, pregnancies involving gestational hypertension or preeclampsia may require fetal surveillance, with the frequency depending on the severity of the condition and other clinical circumstances.

What Evidence Can Help Establish Prenatal Negligence?

A thorough review of the mother’s prenatal and delivery records can help determine what the medical team knew, when they knew it, and what they did in response.

Relevant evidence may include prenatal office records, blood pressure measurements, laboratory results, glucose testing, ultrasound reports, fetal growth measurements, fetal monitoring strips, medication records, hospital records, nursing documentation, and communications between members of the medical team.

The timing of events can be particularly important. A medical expert may need to determine when a concerning condition should reasonably have been recognized, what additional monitoring or treatment was appropriate, and whether an earlier intervention could have prevented or reduced the baby’s injury.

Expert medical testimony is often important because determining whether prenatal care met the applicable standard requires specialized knowledge of obstetric practice and the particular medical circumstances involved.

When Can Failure to Monitor Become Medical Malpractice?

Not every pregnancy complication is evidence of negligence. Obstetrics involves conditions that can develop unexpectedly, and some adverse outcomes cannot be prevented even with appropriate care.

A potential medical malpractice claim generally requires evidence that the healthcare provider failed to meet the applicable standard of care and that this failure caused injury. In a birth injury case, the analysis may involve several related questions: Was the mother’s condition properly identified? Was appropriate testing performed? Were abnormal results recognized? Was the mother adequately monitored? Was the baby’s condition appropriately evaluated? And when warning signs appeared, did the medical team respond in a timely and medically appropriate manner?

The answers depend on the individual medical records and the testimony of qualified experts.

How Kalfayan Merjanian, LLP Helps Families With Birth Injury Legal Claims in California

When a child suffers a serious birth injury, parents may be left trying to understand what happened while also facing extensive medical treatment and uncertainty about their child’s future. Determining whether an injury resulted from an unavoidable complication or from inadequate medical care requires a careful review of the pregnancy, delivery, and medical records.

Kalfayan Merjanian, LLP can help families investigate whether maternal conditions were properly monitored and managed throughout pregnancy and whether a failure to recognize or respond to a developing problem contributed to the child’s injury. Our attorneys work with appropriate medical experts to evaluate the standard of care, causation, and the long-term consequences of a birth injury.

If you believe your child’s injury may have resulted from a failure to monitor or manage a maternal condition during pregnancy, contact Kalfayan Merjanian, LLP to discuss your circumstances and learn more about your legal options.

Frequently Asked Questions

Can preeclampsia cause a birth injury?

Preeclampsia can create serious risks for both the mother and fetus, including problems related to placental blood flow, fetal growth, and premature delivery. If the condition is not appropriately recognized or managed, complications can occur.

Can gestational diabetes cause birth injuries?

Gestational diabetes can increase the likelihood of excessive fetal growth and birth trauma, including injuries associated with shoulder dystocia. Proper monitoring and management can help reduce these risks.

What is cephalopelvic disproportion?

Cephalopelvic disproportion occurs when the baby’s size or position and the mother’s pelvis make vaginal delivery difficult or impossible. It may become apparent as labor progresses and can require changes in the delivery plan.

What should I do if I believe my baby’s injury was caused by inadequate prenatal care?

A birth injury attorney can review the mother’s prenatal records, laboratory and imaging results, fetal monitoring, delivery records, and the child’s medical records. Medical experts can then evaluate whether the care provided met the applicable standard and whether a different course of care could have prevented the injury.

How long do I have to pursue a birth injury claim in California?

The deadlines for medical malpractice and birth injury claims can be complicated and may depend on factors including the child’s age, the nature of the claim, and when the injury or alleged negligence was discovered. Families should obtain case-specific legal advice promptly rather than assuming that a claim is still timely.