BIRTH INJURY (page 156)

Why is the placenta so important in cases of birth injury litigation? Because it provides information about the intrauterine environment during pregnancy....

There may be multiple causes of such an injury (e.g., low blood pressure, hemorrhage, hypoglycemia, infection, seizures) aside from obstetric error. Less than 10% of severe mental retardation can be traced to perinatal causes and for at least 50% of neurologically impaired children there is no identifiable clinical or scientific explanation.

The legal system in the United States charges the prosecution with the burden of proof. Therefore, in birth injury cases the attorney for the plaintiff must address the issue of "cause" and/or negligence and provide evidence the specific injury resulted from the physician's negligence during delivery of the child; this may include an examination of the placenta. The pathologist for the plaintiff must define what is normal for a placenta and must be able to state a normal placenta was found in the case in question. This would be supported by gross and microscopic findings, correlated with the clinical history. In addition, the issue of proper procedure (proper scientific method) for fixation, gross examination (including placental weight and size), umbilical cord measurements, etc. would be evaluated and reviewed. Were appropriate areas selected for microscopic examination? Were adequate numbers of blocks submitted? Were the sections adequately fixed and processed?

The defendant physician can show they followed standard medical practice (i.e., the physician has knowledge of and performs with a degree of skill and care, accepting modern development, that which an average member of the profession would offer to his patients), or their deviation from such practice did not cause or contribute to the injury in question. The defense may also benefit from placental examination, in cases of placental abnormalities which have prenatally caused or contributed to the injury in question. Such findings would suggest nothing the physician could have done would have prevented or caused the injury suggesting it is not a true "birth injury." In one series of 12 cases tried where placental examination was done and testimony provided by a placental pathologist, verdicts in favor for the defense were returned in all cases. Because of this, insurance companies strongly suggest to their clinicians they request placental examination.