The Role of Labor Augmentation in Hypoxic-Ischemic Encephalopathy and Cerebral Palsy

This case study explores the potential link between labor augmentation using Pitocin, placental abruption, and subsequent diagnoses of Hypoxic-Ischemic Encephalopathy (HIE) and possible cerebral palsy in a newborn.

ByWendy Ketner, M.D.

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Published on February 6, 2024

Surgeons performing c-section

Case Overview

This case study delves into a situation involving an adult woman who underwent labor augmentation with Pitocin. Despite this intervention, her labor showed minimal progress, leading to placental abruption.

A Cesarean section was performed. The child born from this procedure exhibited low activity levels and was later diagnosed with Hypoxic-Ischemic Encephalopathy (HIE), with potential cerebral palsy. An expert in pediatric neuroradiology was sought to review the infant's scans taken at seven months and fifteen months post-birth.

Questions to the Neuroradiology expert and their responses

Q1

How frequently do you review radiology for infants suspected of having HIE?

As a triple board-certified professional in Diagnostic, Pediatric, and Neuroradiology, I regularly review radiology for infants suspected of having HIE.

Our team provides services to three large NICUs, including the largest in the state, another is the largest on the West Coast, and a significant university NICU. We discuss imaging every day, even on weekends. Additionally, we serve several small satellite NICUs within our county.

Q2

What are some early changes in imaging suggesting HIE?

The findings depend on whether the infant was preterm or term gestation. For preemies, periventricular white matter injury predominates in mild-moderate HIE resulting in periventricular leukomalacia (PVL).

In term infants, cortical and global symmetric white matter injury predominates in mild-moderate HIE. For both preterm and term infants, profound HIE results in deep gray matter and perirolandic injury. Screening by ultrasound shows edema, and MRI findings include cytotoxic and vasogenic edema.

These findings may be potentiated by neonatal hypoglycemia and accentuated/accompanied by birth trauma.

Q3

Have you ever reviewed a similar case? If yes, please elaborate.

I have reviewed countless similar cases. PVL sequelae are the most significant findings in cerebral palsy patients. Long-term sequelae of HIE are findings to look out for in the kind of case presented here, accounting for the infant brain's myelination state.

About the expert

This expert is a highly experienced pediatric neuroradiologist with over a decade of experience in the field. They are triple board-certified in diagnostic radiology, neuroradiology, and pediatric radiology, having completed prestigious fellowships at renowned children's medical centers. Currently serving as an attending radiologist and neuroradiologist at a top children's hospital, this expert also holds an academic position as a clinical professor of radiology and has contributed significantly to the field with over 65 peer-reviewed journal articles, eight textbook chapters, and two textbooks on topics related to pediatric radiology and neuroradiology.

Expert headshot

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Specialties:

About the author

Wendy Ketner, M.D.

Wendy Ketner, M.D.

Dr. Wendy Ketner is a distinguished medical professional with a comprehensive background in surgery and medical research. Currently serving as the Senior Vice President of Medical Affairs at the Expert Institute, she plays a pivotal role in overseeing the organization's most important client relationships. Dr. Ketner's extensive surgical training was completed at Mount Sinai Beth Israel, where she gained hands-on experience in various general surgery procedures, including hernia repairs, cholecystectomies, appendectomies, mastectomies for breast cancer, breast reconstruction, surgical oncology, vascular surgery, and colorectal surgery. She also provided care in the surgical intensive care unit.

Her research interests have focused on post-mastectomy reconstruction and the surgical treatment of gastric cancer, including co-authoring a textbook chapter on the subject. Additionally, she has contributed to research on the percutaneous delivery of stem cells following myocardial infarction.

Dr. Ketner's educational background includes a Bachelor's degree from Yale University in Latin American Studies and a Doctor of Medicine (M.D.) from SUNY Downstate College of Medicine. Moreover, she is a member of the Board of Advisors for Opollo Technologies, a fintech healthcare AI company, contributing her medical expertise to enhance healthcare technology solutions. Her role at Expert Institute involves leveraging her medical knowledge to provide insights into legal cases, underscoring her unique blend of medical and legal acumen.

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