---
title: "Umbilical Cord Blood Gases: Why They Matter in OB Claims"
description: Missing cord blood gases weaken obstetrical malpractice defense and delay care. Learn when to collect them and how to audit compliance.
image: https://blog.curi.com/hubfs/GettyImages-1489423677.jpg
---

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# Umbilical Cord Blood Gases—A Small Test with Significant Impacts: Defending Obstetrical Care

[Margaret Curtin MPA, HCA, DFASHRM, CPHRM, CPCU](https://blog.curi.com/author/margaret-curtin-mpa-hca-dfashrm-cphrm-cpcu)  Oct 29, 2026

[Risk Management](https://blog.curi.com/tag/risk-management)

![Clinician checking on a newborn baby after delivery](https://blog.curi.com/hs-fs/hubfs/GettyImages-1489423677.jpg?width=960&name=GettyImages-1489423677.jpg)

Years later, memories fade. Objective data doesn't. Curi Advisory’s Margaret Curtin shares why cord blood gases matter for both patient outcomes and defensibility.

In my previous [blog article](https://blog.curi.com/fetal-monitoring-data-retention-obstetrical-malpractice-defense), I discussed the importance of preserving and documenting electronic fetal monitoring (EFM) data. Just as those records can play a critical role in understanding what occurred during labor, another piece of evidence deserves equal attention: umbilical cord blood gases. In obstetrical malpractice cases involving neonatal neurologic injury, we often focus on one key question:

Did something happen during labor and delivery to cause injury to the infant?

The answer isn’t always straightforward, but one of the most valuable pieces of evidence—and frequently overlooked—is the umbilical cord blood gas. Unfortunately, we have seen cases where cord blood gases aren’t collected, and that missing information created challenges not only for neonatal care, but also years later when a case is in litigation.

## Key Takeaways:

- Cord blood gases are among the most objective indicators of a newborn's condition at birth and help guide early clinical decisions.
- Without them, clinicians and defense experts lose information that could clarify causation and timing of injury.
- Standardized collection criteria, staff education, and routine auditing improve consistency, support outcomes, and strengthen defensibility.

## Why Cord Blood Gases Matter

Umbilical cord blood gases provide one of the clearest snapshots of the newborn’s metabolic condition at birth.

This information can help clinicians:

- Identify infants experiencing metabolic acidosis.
- Help determine eligibility for therapeutic hypothermia.
- Better understand the timing and severity of possible hypoxic events.
- Support or challenge allegations of intrapartum asphyxia.

## A Common Defensibility Challenge

From a medicolegal standpoint, cord blood gases may help determine whether significant fetal acidemia was present at birth.

Consider a scenario we have seen in claims reviews: An infant is born after a prolonged labor complicated by intermittent Category II fetal heart rate patterns. The newborn requires extensive resuscitation and is subsequently diagnosed with hypoxic-ischemic encephalopathy (HIE).

Years later, the family filed a malpractice lawsuit alleging delayed recognition of fetal distress and, unfortunately, cord blood gases were not obtained during delivery.

At that point, defense experts are now left without one of the most objective measures regarding the infant's metabolic condition at birth. The opportunity to demonstrate the absence of significant metabolic acidosis—or establish alternative timing of injury—has been lost. Had the cord blood gas analysis been normal, that may have substantially strengthened the defense.

## The Potential Financial Impact of Missing Information

Umbilical cord blood gases often provide critical objective evidence regarding the newborn's metabolic condition at birth. When this information is unavailable, it can be more challenging to demonstrate that severe intrapartum acidemia was absent or to help establish an alternative timing of injury.

| **Evidence Status** | **Potential Effect on Claim** |
| --- | --- |
| Cord blood gases obtained and normal or minimally abnormal | Objective evidence may support defense experts in disputing allegations of intrapartum asphyxia. |
| Cord blood gases not obtained | Increased reliance on retrospective opinions and less objective evidence available to defend causation. |

Birth injury claims involving permanent neurologic injury routinely result in settlements ranging from $1 million to $5 million, with catastrophic cases involving cerebral palsy often exceeding $10 million to cover lifelong care needs. Defense costs alone commonly range from $100,000 to more than $500,000 due to extensive expert review, depositions, and litigation.

## Beyond Defensibility: Improving Outcomes

Cord blood gases are important clinically as well.

Therapeutic hypothermia may improve outcomes for qualifying newborns with moderate-to-severe HIE, particularly when initiated within six hours of birth under established eligibility criteria.

Because timing matters, cord blood gas results may help identify infants who qualify for cooling therapy, potentially reducing the risk of death or long-term disability.

## When Should Cord Blood Gases Be Obtained?

Organizations should standardize indications for obtaining both arterial and venous cord blood gases.

Examples include:

- Operative vaginal deliveries.
- Cesarean delivery for fetal distress.
- Category III fetal heart tracings.
- Persistent Category II tracings that do not respond to intervention.
- Chorioamnionitis.
- Multiple gestations.
- Prematurity.
- Severe fetal growth restriction.
- Maternal fever.
- Low five-minute APGAR score or neonate depression requiring significant resuscitation.

When cord gases are unavailable, organizations should ensure that early neonatal blood gas is obtained when clinically indicated and that the rationale for evaluation, transfer, cooling eligibility, or non-cooling is clearly documented. I’ve found that variability in practice creates risk, and standardization can help reduce it.

# Education and Auditing Are Essential

Having a policy is only part of the solution—healthcare organizations should ensure that all providers and care team members understand:

- When and why to obtain cord blood gases.
- Proper collection techniques and required timeframes.
- Appropriate interpretation and follow-up actions.

Periodic audits should also verify compliance.

# Risk-Reduction Strategies

We recommend organizations:

✓ Develop and maintain a formal organizational guideline for cord blood gas collection.

✓ Validate provider and nursing competency.

✓ Audit all cases involving low APGAR scores.

✓ Review missed opportunities for cord blood gas collection.

✓ Standardize documentation expectations.

# The Bottom Line: Memories Fade—Objective Data Does Not

Cord blood gases provide critical clinical information and may significantly influence medicolegal defense. Organizations rarely regret obtaining them—but they often regret not having them.

# A Proactive Risk Management Opportunity

Curi Advisory’s Risk Consulting Team, powered by ERC Risk, offers Obstetrical Clinical Risk Assessments that evaluate neonatal resuscitation practices, cord blood gas processes, documentation, and interdisciplinary communication to identify opportunities for improvement before an adverse event occurs.

The assessments evaluate high-risk clinical practices, including:

- Electronic fetal monitoring interpretation and competency
- Emergency cesarean delivery response
- Communication and escalation processes
- Documentation practices
- Shoulder dystocia preparedness
- Obstetrical emergency simulation
- Teamwork and culture of safety
- Policies, procedures, and guideline compliance
- Medical malpractice defensibility

We partner with hospitals, health systems, and physician organizations nationwide to identify clinical and operational risks before they result in patient harm or medical malpractice claims.

Whether your goal is improving patient outcomes, strengthening your medical malpractice defense, preparing for underwriting review, or reducing organizational risk, our experienced obstetrical risk consultants can help.

Contact my team at [risk.consulting@curi.com](mailto:risk.consulting@curi.com) to learn more about an Obstetrical Clinical Risk Assessment. 

##### ``

---

**References**

- [https://www.expertinstitute.com/resources/insights/jury-awards-family-30-55m-for-failure-to-monitor-fetus-heart-rate/](https://www.expertinstitute.com/resources/insights/jury-awards-family-30-55m-for-failure-to-monitor-fetus-heart-rate/)
- [https://www.lubinandmeyer.com/cases/fetal\_heart\_rate.html](https://www.lubinandmeyer.com/cases/fetal_heart_rate.html)
- [https://www.medlawhelp.com/blog/fetal-decelerations-29m/](https://www.medlawhelp.com/blog/fetal-decelerations-29m/)

*The content contained herein was generated by Curi Advisory with the assistance of an AI-based system to augment the effort.*

*These resources and guidance are offered for educational and risk management purposes only. This information is not medical or legal advice, does not replace independent professional judgment, does not constitute an endorsement of any kind, should not be deemed authoritative, and does not establish a standard of care in clinical settings or in courts of law. If you need legal advice, you should consult your independent/corporate counsel. We have found that using risk mitigation efforts can reduce malpractice risk; however, we do not make any guarantees that following these risk recommendations will prevent a complaint, claim, or suit from occurring, or mitigate the outcome(s) associated with any of them.*

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### About the Author

![](https://blog.curi.com/hubfs/Margaret%20Curtain.png) 

[Margaret Curtin MPA, HCA, DFASHRM, CPHRM, CPCU](https://blog.curi.com/author/margaret-curtin-mpa-hca-dfashrm-cphrm-cpcu)

 Margaret Curtin joined the Curi Advisory team in 2023, as Program Director for its risk consulting arm offering clinical risk assessments, claim management, practice management and education support services to hospitals, healthcare organizations and physician groups. With over 30 years of experience in risk management and patient safety, Margaret is a well-known leader in the field.

In addition to the medical professional liability insurance industry, she has first-hand healthcare experience, having worked in acute, managed, and ambulatory care settings. Throughout her career, Margaret has also held positions in provider relations, contracting, business development, marketing, education, and underwriting.

She is a published author and frequently speaks at industry events and conferences. Margaret is a certified coach and Five Behaviors Certified Practitioner with Wiley in association with Patrick Lencioni. Focusing her coaching practice on leadership and unlocking the power of teamwork for aspiring professionals in the healthcare and the insurance industries.

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