Medical Malpractice FAQ

The APGAR score is the result of a test given to your baby immediately after birth. The test is meant to quickly evaluate your baby’s condition to determine whether there is a need for additional care, including emergency care.

The score reflects an assessment of five factors: activity and muscle tone; pulse; grimace response; appearance (skin color); and respiration.

An APGAR score of 7 or above within one minute of birth generally is indicative of a healthy baby. Lower scores, however, do not necessarily mean that your baby is unhealthy. Rather, your baby may merely require some help with things like suctioning or oxygen. Your baby will be tested again at 5 minutes and, sometimes, at 10 minutes.

Points in the APGAR scoring system are assigned as follows:

Most babies with low APGAR scores will end up fine. The APGAR score is a method used to quickly assess whether the baby needs extra care or monitoring. If your baby has a low APGAR score, your doctor or midwife should explain to you how your baby is doing, what might be causing the problem, and what care is being given.

Rarely, a baby does not receive the necessary care and is injured as a result. Sometimes, a low APGAR score reflects a lack of oxygen prior to, during, or immediately after birth that may have caused damage to the baby’s brain — a condition sometimes referred to as birth asphyxia.

Prenatal is a reference to the period of time in a pregnancy between conception and birth.

Eclampsia is a condition in pregnant women with high blood pressure and is characterized by the occurrence of otherwise unexplained seizures. It is sometimes thought to be the end stage of “preeclampsia,” but this is a subject of some controversy.

Though rare, eclampsia is a serious condition that requires timely diagnosis and management to protect both the mother and the unborn child. Treatment is typically aimed at preventing low oxygen levels; controlling blood pressure; preventing seizures; and planning for delivery.

Eclampsia usually occurs after the 20th week of gestation (although it can occur prior) and is most common within 48 hours of labor.

Preeclampsia is a disorder that occurs in 5-8% of pregnancies and is a leading cause of maternal and infant injury and death. The disorder is characterized by abnormally high blood pressure and protein in the urine.

Not all women with preeclampsia are symptomatic. However, some common symptoms include sudden weight gain, vision changes, headaches, and swelling. These symptoms typically present after the 20th week of gestation.

Preeclampsia is a rapidly progressing condition that requires timely diagnosis and management in order to ensure safety of both mother and child.

Eclampsia, pregnancy-induced hypertension (PIH), toxemia, and HELLP Syndrome are related conditions or manifestations of preeclampsia.

A breech birth is a birth that occurs with the baby entering the birth canal feet first or buttocks first instead of the normal head-first presentation. Breech births often occur in premature deliveries and when there are multiple babies, uterine abnormalities, or other anomalies.

Breech deliveries can subject the baby to unnecessary risk of birth trauma. A breech presentation should be diagnosed in advance of labor and delivery. In some instances, the breech baby can be maneuvered in a procedure known as external cephalic version (ECV). If the baby remains in a breech position, a determination must be made between vaginal delivery and Caesarean section.

A central line is a catheter (tube) that is passed through a vein (usually below the neck) and into either the main vein returning blood to the heart or the heart itself.

Central lines allow for concentrated infusions of medicine to be administered with less risk of complication than peripheral intravenous infusions and other methods of medicine delivery.

One risk of central line placement is infection. However, there are established procedures available that, if followed, essentially eliminate central line-related infection. Before you allow a central line to be placed, ask about your hospital’s infection rate. Less than 1 in 1,000 is very good. An infection rate of 1-3 in 1,000 is acceptable. Above 3 in 1,000 is unacceptable. Other things to ask about include:

• Does the hospital use ultrasound imaging to guide placement of the central line? They should. This technology greatly increases accuracy and safety.
• Before starting, did your doctor or nurse wash their hands, put on sterile gloves, and wear a mask? If they didn’t (or if they touched anything else in the room before getting started), insist that they do so (or that they do so again).
• Make sure that the central line is in. Ask for a saline test before the medication is introduced. If the skin around the injection site bulges, then the line is not in correctly.
• Continually ask if the central line needs to stay in. The longer a line is in, the greater the risk of complication. Ask you doctor daily if the risk of keeping the line is outweighed by the benefit.

A Caesarean section is the delivery of a child via incisions in the mother’s abdomen (laparotomy) and uterus (hysterotomy).

A colonoscopy uses a flexible tube and tiny camera lens passed through the anus to provide an image of the full colon, four or five feet in length. Virtual colonoscopy, using multidimensional images from CT scans, is a non-invasive version of this test, but its effectiveness is still under investigation. The colonoscopy allows a physician to visualize the colon and, when warranted, biopsy tissue or remove polyps.

This is a non-invasive test for the presence of non-visible blood in the stool (or feces). The test is so simple that it is sometimes taken at home. A positive FOBT does not mean that you have cancer. There are multiple causes of blood in the stool. But it is an important factor that your doctor should consider in determining whether additional testing or evaluation is required.

A sigmoidoscopy is the visual examination of the last two feet of the colon using a tiny camera on a flexible tube passed through the anus. It is often used as a screening tool for full colonoscopy.

Encephalopathy is a general reference to any disease or disorder of the brain. It is sometimes diagnosed in children with birth injuries who display symptoms including seizures or delayed development, or who require ventilation.

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