Pregnant Women, Car Accidents, and the Unborn Baby

Studies have proven that an expectant mother's actions immediately following an automobile accident are critical to ensuring the best possible treatment, follow-up care, and overall outcome for the mother-to-be and her unborn child.

The risks of increased complications following an automobile accident are exponential and warrant heightened observation by medical professionals. A trained professional will be able to provide an expectant mother with specialized treatment that is specifically designed for her pregnant state. For instance, certain types of traditional physical therapy may not be suitable for an expecting mother.

Car crashes present a number of risks. The more serious types can include: pre-term labor, miscarriage, internal bleeding, hemorrhaging, birth defects, and creating a high-risk pregnancy that did not exist before the crash. A high-risk pregnancy can create complications before, during, and/or after the birth. These complications can affect both the mother and her unborn child.

More subtle risks for a pregnant woman may include stress and emotional duress. This type of mental anguish can result from the trauma of the accident or the long-term mental stress caused by birth complications, or, in extreme cases, the loss of a child. This type of emotional duress warrants legal representation for the expectant mother and her unborn child.

Call 911 or other emergency services right away if you think you need emergency care after an auto accident, or if you experience any of the following:

• You pass out (lose consciousness).
• You are experiencing severe vaginal bleeding.
• You are experiencing severe pain in your belly or pelvis.
• You are experiencing gushing/leaking fluid from your vagina, and you think, or you know, that the umbilical cord is bulging into your vagina. If this occurs, immediately get down to your knees so that your buttocks is higher than your head. This will decrease the pressure that is on the umbilical cord until medical help can arrive to assist you.
  

WHEN TO CALL YOUR DOCTOR AFTER AN ACCIDENT:
Any pregnancy can become high risk at any time, there are no guarantees. And although the occurrence of any of the following symptoms may not necessarily indicate that the expectant mother is having a problem, you should call your doctor immediately if you experience any of these conditions after an automobile accident:

• vaginal bleeding or spotting
• swelling in your face or fingers
• a leakage of fluid or increased vaginal discharge
• severe or unrelenting and constant headaches
• pain in your abdomen or shoulder areas
• persistent vomiting that is not connected to morning sickness
• chills or a fever
• a noticeable change in the frequency or strength of your baby's movements
• painful or urgent urination
• faintness or dizziness

Initial Questions an Expectant Mother may have following an Auto Accident

What is a high-risk pregnancy?

Simply put, your pregnancy is considered high-risk if you or your baby have suffered an injury and have thus increased the chances of health complications. Automobile accidents significantly attribute to a woman’s chances of having a high-risk pregnancy. If you have been in an accident, even a minor fender bender, it is imperative that your doctor closely monitor you during your pregnancy to find or detect any problems may arise.

IMPORTANT: it is possible that an expectant mother’s fetus can suffer severe injury in an instance where no physical contact was made. A quick stopping motion can expose a mother and her fetus to a type of injury known as a contra-coup injury. This occurs when a concussion or shock is produced by a blow or other injury, in a part or region of the body opposite to that at which the blow is received, which often causes rupture or disorganisation of the parts affected.

The after-effects of an auto accident may place you and your unborn at higher risk for problems, such as slowed growth for the baby, any preterm labor complications, elevated stress levels and blood pressure, pre-eclampsia, and problems with the placenta. However, it's important to remember that being at high risk doesn't mean that you or your baby will automatically have problems.

It’s possible that your doctor or primary care physician may decide to induce labor if he or she believes that your health, or that of your baby's, could be at risk.

What type of doctor will you need to see during a high-risk pregnancy?

Women will sometimes visit a doctor who specializes in high-risk pregnancies. These doctors are called maternal-fetal specialists, or perinatologists. In addition to these doctors, you may also be required to see your regular doctor. Because high-risk pregnancies require additional medical care, their costs greatly outweigh those of a normal pregnancy. Keller & Keller LLP is often able to help soon-to-be mothers recoup these costs.

What are some of the possible negative complications, consequences and outcomes of an auto accident involving a pregnant woman?

--Miscarriage--

What is a miscarriage?

Miscarriage, or spontaneous abortion, is the accidental and involuntary loss of a fetus before the 20th completed week of pregnancy. An expectant mother can also have what is called a partial miscarriage. This occurs when only part of the fetal tissue is expelled from the uterus after a miscarriage. (This can also be called missed spontaneous abortion or an incomplete abortion.)

The birth of a fetus that does not have a heartbeat after 20 weeks of pregnancy is labeled as a stillbirth.

Symptoms of a miscarriage include:

• Vaginal bleeding that can be either heavy, light, constant or irregular bleeding. Although the bleeding is usually the first or principal sign of a miscarriage, bleeding can occur during the 1st trimester and may also occur with a completely normal pregnancy. However, bleeding that is accompanied by pain and discomfort is and can be a sign that miscarriage is more likely, especially after a trauma or injury.
• General Pain. Pelvic cramping, abdominal discomforts and pain, or a persistent, dull aching in your lower back. It’s very important to note that pain after an auto accident may not be immediate, and may start a few hours to several days after bleeding has begun.
• Blood clots or grayish (fetal) tissue passing from the vagina are an additional sign of miscarriage.

It is not always easy to tell whether a miscarriage is taking place. Seeking professional medical treatment after an accident is always the best course of action.

--Premature Infant--

What is a premature birth?

A normal pregnancy lasts approximately 9 months, or 40 weeks. A baby born prior to week 37 is premature. Many premature babies--those born closer to the 37 weeks date--do not have problems.

Babies who are born closer to the 7 month date, 32 weeks may not be able to eat on their own, breathe on their own, or stay warm on their own. But after these babies further develop, most of them can leave the hospital safely.

Babies born earlier than about 6 months, 26 weeks are the most likely to have serious problems. If the expectant mother’s baby was born very small or sick, there may be the possibility of having to face a difficult and grim life-or-death decision about the path of treatment for the new baby.

Having an empathetic attorney can be critical in this instance, as they will be able to start legal proceedings on your behalf and speak with insurance adjusters at a time when you should be surrounding yourself with family and loved ones. This type of litigation can be delicate and emotionally charged, so be sure that you contact an attorney that specifically handles personal injury.

Medical professionals often call premature babies "preemies."

Why is premature birth a problem?

Babies born prematurely may not be able to be fed by normal means through their mouth. They are most likely going to be tube-fed, or fed through an IV, depending on their condition and the situation. Tube-feeding can last until the baby is capable enough to breathe, suck, and swallow, and can feed by normal means through the breast or bottle. Also, until the newborn baby is capable of maintaining their own body heat, they are kept warm in a special bed called isolette.

Babies that are born prior to completing growth inside the womb simply need more time to fully develop and finish their growing, than a baby that goes full-term. It is only after the premature baby (preemie) outgrows his or her problems and complications caused by an early birth that they are sent home.

Another issue that can arise when a baby is born premature or early, is that their major organs have not finished completely growing. This complication can also cause serious health problems. Any premature baby can have medical problems, but babies born before 32 weeks are even more susceptible to have more serious, costly medical problems. This furthers the notion that auto accidents can cause a stressful, daunting, frightening and expensive pregnancy.

What kind of treatments might a premature infant need?

Premature babies can require much more care and medical support than a full-term baby and are usually moved to the neonatal intensive care unit (NICU). Once moved to the NICU, the premature babies are monitored for any type of complications that could arise. These changes or complications can range from an infection to changes in breathing and heart rate, or the need for medicine--a few may even require surgery. This extra care can become very costly, very quickly.

Sick and very premature infants need special treatment as mentioned previously, and depending on what medical problems they have, those who need help breathing would need to be aided by an oxygen tube or a machine, called a ventilator, which helps to simulate the normal breathing functions and moves air in and out.

Does premature birth cause long-term problems?

It is not easy to predict how healthy a premature baby will be prior to the baby being born, especially if the premature birth is a result of trauma induced or accident related and comes incredibly sudden, but no matter the situation, a medical professional is the best resource to help prepare you for whatever condition may arise. Your doctor will devise a plan of action regarding treatment based on your individual condition and how many weeks pregnant you will be when you are likely to give birth.

Premature babies do not always develop serious disabilities, however the earlier a baby is born; the higher the risk for disabilities.

Babies most likely to experience a long-term disability are those who are born before 26 weeks, or who are very small, 1.7lb or less.

Long-term disability problems may include mental retardation or cerebral palsy.

--Placenta Abruption--

What is placenta abruption?

During a normal pregnancy for the expectant mother, the placenta will be attached firmly to the inner walls of the uterus until the baby is ready to be born. Placenta abruption is the premature separation or abruption of the placenta before the expected or desired time frame for the birth. This can occur from any number of things, such as trauma from an auto accident.

Since the round, flat placenta is considered the lifeline that supplies everything that the fetus needs from the expectant mother; an abruption can be incredibly dangerous, and even life-threatening for the fetus, and sometimes for the mother, depending on the extent of the injuries.

Placenta abruption can lead to several problems that have already been discussed such as: pre-term birth, low birth weight and large blood loss for the expectant mother. Reports even indicate that in some infrequent situations, the placenta abruption can lead to the fetus dying.

Can an automobile accident cause placenta abruption?

The causes of placenta abruption are not well understood, and some women develop it without any identifiable cause. But you can reduce your risk by treating or avoiding some of the known risk factors that have been linked to placenta abruption.

One of the common risk factors that can cause an expectant mother to have a placenta abruption include having undergone physical injury or trauma to the uterus. Having been in a car crash, minor or large, is a highly probable source for this type of injury.

What are the common symptoms that could arise?

If you have developed placenta abruption, you may notice one or more symptoms, including: vaginal bleeding, a tender, painful, or hard, rigid-feeling uterus, signs of preterm labor, including regular contractions, lower back or abdominal ache or pain.

The amount of vaginal bleeding is not necessarily a good measure of how severe an abruption is. Heavy bleeding can even sometimes be the least apparent, as a large amount of blood can stay trapped between the uterine wall and placenta. Heavy blood loss can cause multiple symptoms that include: shock, dizziness, faintness, weakness, disorientation, restlessness, and shallow, quick breathing.

--Dealing with a Loss--

Losing a baby is an incredibly agonizing and heartbreaking experience. No matter how early, or how far into a pregnancy, these feelings can be sometimes overwhelming and too much to deal with. When a sudden loss occurs as a result of a car or truck accident, expectant parents might not know where to turn.

Keller & Keller LLP has handled these types of cases with grace, dignity and the utmost care for our clients throughout our many years of personal injury practice. Providing grieving, expectant parents with professional legal counsel has always been a responsibility that deserves our undivided attention.

Although you may initially feel alone in your experience, you will begin to discover, as you talk with us about your loss, that miscarriages, stillbirths, and neonatal death resulting from car crashes happen far more frequently than most of us are led to believe.

Statistics:

Between the years of 1995 and 1999, there were more than 30,000 pregnant women involved in auto accidents every year!

• In Indiana: almost 900 traffic fatalities in 2007
• In the US: almost 40000 traffic fatalities in 2007

There are about 5 times as many fetal deaths due to pregnancy-related crashes than there are infant-related crash deaths; however, these deaths are not reported individually on crash reports.

A fetus is 15 times more likely to die from a motor vehicle crash than a child 0-14 is likely to die from a firearm injury.

On average, 2.3% of women report being hurt in a “car accident” during pregnancy.

Motor vehicle injuries are the leading cause of maternal and fetal injury death and maternal injury hospitalization.

On average, more than one fetus a day dies from a car accident as a result of injuries sustained during that crash.

It is estimated that there are at least 3,500 annual hospital visits in the US for a pregnancy-related car accident injury, yet no state or agency tracks these events on an ongoing basis.

The risk of adverse fetal injury (defined as either placental abruption, uterine rupture, direct fetal injury, maternal death or fetal loss) in a 16 MPH frontal crash at 28 weeks gestation is 26% for belted drivers and 70% for unbelted drivers.

The total annual miles driven by women of reproductive age increased 275% from 1969 to 1990. This represents a major increase in fetal exposure to crash risks over the last 30 years

Unofficially…
Babies who are born prior to 25 weeks, and who weigh more than two pounds have a 50% chance of survival if they're born in a hospital that is equipped to deal with a baby who is this premature. However, on the other hand, babies who weigh in at three pounds or more have a 95% chance of survival.

Additional Questions Expectant Mothers Might have after an Auto Accident:

1. What should I do if I'm in a car accident while I'm pregnant?

Any time you're in a car accident — whether it's a fender-bender or a multiple-car pileup — you should be examined as soon as possible, no matter how far along you are in your pregnancy. Time is critical in these types of crashes. (In fact, you should be evaluated if you ever receive any type of blow to the abdomen during pregnancy.) Even if you feel fine, call your health care provider, or head to an emergency room right away.

While the womb does offer some of the best protection for your baby and placenta during a sudden impact, slamming on the brakes — even if the resulting jerk is not or does not feel severe — can potentially disconnect the placenta from the uterus. This is when a placental abruption is possible, and as discussed, this can lead to serious problems including hemorrhage, miscarriage, or premature delivery.

Once in the emergency room, the expectant mother will be examined to determine if everything is ok and the baby and mother are deemed stable. This should include an ultrasound and full OB examination. Depending on the age of the fetus and any symptoms you have, such as bleeding or contractions, the medical professionals may determine that you and your baby need to be monitored for a longer duration of time. Also, if the expectant mother’s blood is Rh-negative, she may receive a shot of Rh immunoglobulin if there's any chance that your blood has mixed with your baby's.

The medical professionals should explain all of this to the expectant mother during the treatment. If the expectant mother is giving a good report, she will still need to watch for subsequent vaginal bleeding, leaking fluid, contractions or other abdominal pain, or a decline in the baby's movement. If you experience any of these symptoms, contact medical professionals immediately.

2. Should I have an early fetal ultrasound?

Yes, because a fetal ultrasound is performed to better understand the health and status of the fetus. A large amount of information is obtained through this ultrasound.

3. I feel fine, is it possible that there are injuries to myself or my unborn baby?

Yes, because pregnant women are at risk after car crashes—even if there are not any apparent or visible injuries to the naked eye.

Pregnant women who are hospitalized following motor vehicle crashes are at increased risk of adverse pregnancy outcomes, even if they are not seriously injured or not injured at all. These women are at risk for such difficulties as placental abruption and cesarean section and their babies at risk for respiratory distress syndrome and fetal death, according to a new study by investigators at the Harborview Injury Prevention & Research Center (HIPRC).

An investigation conducted on over 600 expectant mothers who had to be hospitalized after an automobile accident revealed that a third were reported as uninjured, half were reported as having minor injuries, and 1 in 7 were reported as having severe injuries.

Even though previous studies have uncovered that the severity of the crash is connected to negative pregnancy results, newer, more up to date research reveals that even injuries that are deemed ‘not as severe’, can also have negative and harmful results for the expectant mother and her baby.

Expectant mothers who were in an automobile accidents and did not display or have any recorded injuries, were discovered to be at an incredibly higher risk level for any number of premature labor complications compared to those expectant mothers who were not in automobile accidents.

4. What could go wrong mentally? Physically? I was wearing my seat-belt and I am not experiencing any pain.

Several things can go wrong mentally and physically even if you, as the expecting mother, were wearing your seat-belt and initially think everything is fine. Any type of blow to the abdomen, including a tightening seatbelt or an airbag that deploys can create trauma for the unborn fetus. Any of these issues could cause mental distress that is not initially present.

--Placental Abruption--

A big concern for the expectant mother after an automobile accident should be placental abruption. As discussed earlier, this is the condition that results in the placenta tearing away partially or fully from the uterine wall. This puts the baby in great distress as it cuts off all incoming and outgoing life support from the expectant mother to the fetus.

--Contractions--

Any type of impact or sudden stopping motion within a vehicle, with or without a placental abruption, can potentially cause the expectant mother to have contractions. The concern here is that contractions could lead to early labor and delivering prematurely. Receiving medical care after an automobile accident is very important if the expectant mother is having contractions.

--High Blood Pressure--

Pregnant women tend to have higher than normal blood pressure. A traumatic experience such as an automobile accident can cause unnecessary stress and in turn raise the expectant mother’s blood pressure even further.

Any number of other physical issues not mentioned here, could also arise, thus it is imperative to always seek the opinion of a trained medical professional.

5. Could my car accident have caused preterm labor?

Yes, preterm labor has long been associated with trauma, including blunt force injuries that can be sustained from automobile accidents.

One such cause can arise from the force/pressure of a seatbelt against an expectant. Possible injuries that can arise from this contact can cause rare uterus ruptions as well. However, seatbelts are still incredibly highly recommended at all times, even during pregnancy.

--DEFINITIONS--

A

Amniocentesis - a test performed to determine chromosomal and genetic disorders and certain birth defects. The test involves inserting a needle through the abdominal and uterine wall into the amniotic sac to retrieve a sample of amniotic fluid.

Amniotic fluid - The fluid bathing the fetus and serving as a shock absorber

Amniotic sac - a thin-walled sac that surrounds the fetus during pregnancy. The sac is filled with amniotic fluid - liquid made by the fetus and the amnion (the membrane that covers the fetal side of the placenta) which protects the fetus from injury and helps to regulate the temperature of the fetus.

Agar test - A scoring system to evaluate the condition of the newborn immediately after birth.

C

Congenital anomalies – Defects present at birth.

Cervix - the lower part of the uterus that projects into the vagina. Made up of mostly fibrous tissue and muscle, the cervix is circular in shape.

E

EDD - estimated due date.

Embryo - the fetus is first called an embryo during the first eight weeks after conception.

Episiotomy - an incision through the vaginal wall and the perineum (the area between the thighs, extending from the anus to the vaginal opening) to help deliver the fetus.

F

Fetal distress – nonreassuring fetal status

Fetal ultrasound - a test done during pregnancy that uses reflected sound waves to produce a picture of a fetus, the organ that nourishes the fetus (placenta), and the liquid that surrounds the fetus (amni

Disclaimer

WHAT'S MY CASE WORTH?