Hypoxic Ischemic Encephalopathy (HIE) in Twins: Medical Malpractice

When a mother gives birth to more than one baby at time (multiple births), the babies face greater chances of suffering from hypoxic ischemic encephalopathy (HIE). Hypoxic ischemic encephalopathy, a dangerous neonatal brain injury caused by oxygen deprivation, often leads to permanent disabling conditions and injuries including cerebral palsy (CP), periventricular leukomalacia (PVL), neurodevelopmental impairments, intellectual and developmental disabilities (I/DD), seizure disorders and epilepsy, and more.

Throughout this page, our Michigan birth injury lawyers will explain hypoxic ischemic encephalopathy (HIE) in twins in order to help you understand how twins and multiples are more susceptible to the brain injury. We’ll cover the most common complications associated with delivering twins or multiples and explain how instances of medical malpractice can cause these complications. Additionally, we’ll provide the information and resources necessary for your family to adjust to life with a hypoxic ischemic encephalopathy (HIE) diagnosis.

If you believe medical malpractice caused your loved one’s injuries, disabilities, cerebral palsy, or hypoxic ischemic encephalopathy, we encourage you to contact Michigan Cerebral Palsy Attorneys today. Our team, which consists of experienced legal and medical professionals, will review your case for free, answer your questions, and inform you of your legal options. To contact our Michigan cerebral palsy and HIE lawyers, please call us toll-free at (888) 592-1857, fill out our online contact form, press the Live Chat button to the left of your screen, or click the following contact button.

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Multiple Births and Hypoxic Ischemic Encephalopathy (HIE): Quick Facts

What are multiple births?

Multiple births, also known as multiple gestations or multifetal births, are pregnancies that yield more than one baby during a single delivery. For example, twins and triplets are considered multiple births. Multifetal births may be identical (monozygotic) or fraternal (dizygotic).

What is hypoxic ischemic encephalopathy (HIE)?

Hypoxic ischemic encephalopathy (HIE), also known as intrapartum asphyxia, neonatal encephalopathy (NE), and birth asphyxia, is a form of neonatal brain damage that occurs when an infant suffers oxygen deprivation around the time of delivery. Since HIE is the result of blood and oxygen deprivation to the baby’s brain, the injury is often the result of problems with the uterus, placenta, or umbilical cord. Other common causes of HIE include premature delivery, infant or maternal infections, prolonged labor and delivery, or C-section mistakes. Hypoxic ischemic encephalopathy commonly leaves infants with permanent brain damage and related conditions—many babies that suffer from HIE at birth go on to develop seizure disorders, epilepsy, cerebral palsy (CP), intellectual and developmental disabilities, neurodevelopmental disabilities, hydrocephalus, learning disabilities, and motor control issues.

Twins, Hypoxic Ischemic Encephalopathy (HIE), and Birth Injury

What Complications Are Associated with Twin Births?

Giving birth to twins, triplets, or additional multiples increases the likelihood that one or more of the babies will suffer from a range of birth injuries. Many of these birth injuries are known to cause oxygen deprivation, hypoxic ischemic encephalopathy (HIE), and/or cerebral palsy (CP).

The following birth complications and injuries are more common in twins or other multifetal pregnancies:

  • Premature birth (preterm birth; preterm delivery): Twins are more likely to be born prematurely than single gestations. Because premature babies are often born without the strong, fully-developed systems necessary to withstand delivery and/or life outside the womb, they can be susceptible to a number of complications, injuries, illnesses, and other problems. Premature infants may suffer from respiratory issues (from overventilation, hypocarbia, and underdeveloped lungs), brain bleeds (intracranial hemorrhages), sepsis and meningitis, neonatal hypoglycemia, jaundice and kernicterus, apnea of prematurity, and more.
  • Umbilical cord complications: Twins are more likely to experience umbilical cord complications from cord entanglement. Umbilical cord entanglement can cause umbilical cord compression, a complication that restricts the flow of oxygen, blood, and nutrients through the umbilical cord. When a baby fails to receive adequate amounts of oxygen and blood, his or her chances of developing hypoxic ischemic encephalopathy rapidly increase.
  • Fetal Growth Restriction (FGR) / Intrauterine Growth Restriction (IUGR): Babies with IUGR/FGR grow at an abnormally slow rate within the womb and are, therefore, smaller than average for their gestational age. While a number of factors may cause intrauterine growth restriction, the most common causes are placental insufficiency, poor nutrition in the mother and a shortage of oxygen and nutrient supply to the baby. In twin pregnancies, both babies share the same placenta. One baby’s umbilical cord may attach to the placenta in a better place than the other baby’s, ultimately allowing that baby to receive more oxygen, blood, and nutrients. In these cases of unequal placental sharing, one twin is at a greater risk for oxygen deprivation and hypoxic ischemic encephalopathy (HIE) than the other.
  • Blood Pressure Complications: Preeclampsia is a disorder characterized by high blood pressure in the second half of a mother’s pregnancy. Preeclampsia can diminish the flow of blood to the placenta, increase the mother’s chance of placental abruption, and increase the likelihood of a maternal seizure. Gestational hypertension is a complication in which maternal high blood pressure is first detected after twenty weeks of gestation. Gestational hypertension occurs without any sign of preeclampsia, and it can interfere with blood flow to the placenta. Both preeclampsia and gestational diabetes can interfere with the passage of oxygenated blood flow to the fetus, thus increasing the chances of hypoxic ischemic encephalopathy.
  • Twin to Twin Transfusion Syndrome (TTTS): Twin to twin transfusion syndrome is a pregnancy complication that occurs when the blood vessels of two identical twins are connected and one twin receives more oxygenated blood from the placenta. Failure to diagnose and treat twin to twin transfusion syndrome may result in hypoxic ischemic encephalopathy (HIE), another birth injury, or even fetal death.

Many other complications associated with twin or multiple births can cause oxygen deprivation and infant brain damage. Some others include premature rupture of membranes (PROM), emergency C-sections and C-section mistakes, head trauma, and the misuse of delivery assistance tools. Since hypoxic ischemic encephalopathy (HIE) in twins is more common than hypoxic ischemic encephalopathy in single births, medical professionals must take great precaution and closely follow all standards of medical care. The failure to properly diagnose, treat, manage, or prevent a twin complication that leads to hypoxic ischemic encephalopathy or another birth injury is medical malpractice.

Preventing Hypoxic Ischemic Encephalopathy (HIE) in Twins & Multiples

Testing and Diagnostics Used to Prevent Hypoxic Ischemic Encephalopathy (HIE) in Twins & Multiples

It is crucial that medical professionals provide thorough prenatal evaluations in pregnancies with twins or other multiples. The only dependable way to detect twins or multiples is through ultrasonic evaluation. Conducting early ultrasounds will allow medical professionals to take a more accurate reading of the number of fetuses, gestational age, and whether the fetuses are identical or fraternal. These evaluations allow medical professionals to better evaluate and foresee risk factors for premature delivery, intrauterine growth restriction, twin to twin transfusion, and other dangerous complications.

Because dangerous injuries and complications like hypoxic ischemic encephalopathy (HIE) are more common in twins, it is critical for medical professionals to conduct prenatal tests more frequently. In order to determine umbilical cord implantation, detect intrauterine growth restriction (IUGR), or diagnose other complications, medical professionals use ultrasonic testing, Doppler ultrasounds, nonstress tests, amniotic fluid volume tests, and biophysical profiles (BPPs).

Planning Labor and Delivery to Prevent Hypoxic Ischemic Encephalopathy (HIE) in Twins and Multiples

Twins are more likely to require intensive medical care right after birth. A team of medical specialists must be present at delivery and prepared to handle the babies’ medical needs, so the delivery of twins or multiples should be scheduled ahead of time. The pediatric team must be prepared for cardiovascular support, respiratory upkeep, infant resuscitation, surgery, emergency C-section, and other medical procedures. Planning early delivery ahead of time will decrease the babies’ chances of developing hypoxic ischemic encephalopathy (HIE) and permanent brain damage. Strict medical guidelines are in place regarding the timing of delivery for multiple births (particularly those with additional present complications or risk factors), and medical professionals are obligated to follow them. When the failure to do so results in harm to the mother or babies, it is medical malpractice.

Legal Help for Hypoxic Ischemic Encephalopathy (HIE) in Twins & Multiples

Michigan Birth Injury, Hypoxic Ischemic Encephalopathy (HIE), and Cerebral Palsy (CP) Lawyers

Because twin birth injuries and hypoxic ischemic encephalopathy (HIE) cases are so complicated, it is critical to find an attorney from a law firm that specializes solely in birth injury lawsuits. At Michigan Cerebral Palsy Attorneys, our birth injury lawyers have handled cases related to hypoxic ischemic encephalopathy (HIE) in twins for decades. Consistently securing million-dollar settlements for their clients, the birth trauma lawyers at our Detroit, Michigan law firm are committed to working closely and effectively with your family to obtain the resources necessary for a life of rehabilitation, equal opportunity, and well-being.Michigan Hypoxic Ischemic Encephalopathy (HIE) Lawyers - Twins

If your loved one was diagnosed with permanent injuries or disabilities including cerebral palsy, seizure disorders, periventricular leukomalacia (PVL), intellectual and developmental disabilities (I/DD), or others, we encourage you to reach out to Michigan Cerebral Palsy Attorneys today. With over 50 years of combined experience in the field of birth injury, our lawyers have the skills and experience necessary to secure the resources your family needs. Hypoxic ischemic encephalopathy (HIE) in twins and multiples is dangerous and, unfortunately, often the result of medical malpractice. Take the first step towards a better life for your family today.

For a free case review, please contact our Michigan HIE and birth injury lawyers in any of the following ways. Our birth trauma lawyers will answer your questions free of charge and inform you of your legal options.

Call us toll-free at (888) 592-1857

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Related Reading:


Chasen, Stephen T., MD, and Frank A. Chervenak, MD. “Twin Pregnancy: Prenatal Issues.” UpToDate (n.d.): n. pag. Twin Pregnancy: Prenatal Issues. Web. 15 May 2015. <http://www.uptodate.com/contents/twin-pregnancy-prenatal-issues?source=search_result&search=twin+pregnancy&selectedTitle=1~150>.

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