ReviewObstetric malpractice litigation and cerebral palsy in term infants
Section snippets
Malpractice litigation
Most parents expect to give birth to a healthy, normal baby and are deeply disappointed when their expectation is not fulfilled. Encouraged by earlier research suggesting that EFM (electronic fetal monitoring) in labour could help to deliver a baby in good condition,1 many also believe that good perinatal outcome is exclusively dependent on a high standard of antenatal and delivery care, which is both the norm and their right.
Advances in medical care in recent decades have led to increased life
The diagnosis of obstetric injury causing CP
It is appropriate to consider the process by which obstetric injury is diagnosed as the cause of CP.
CP is an umbrella term for “permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain”.6, 7 Despite being a permanent and non-progressive brain lesion, the clinical signs can change over time as the child develops. Reviewing the child’s progress is necessary
Risk factors and causation
In total Western Australian population CP data, almost 80% of CP occurs in term or near term infants.12 In birth years 95–99, 65% of CP was born at term and a further 14.2% was born at 32–36 weeks. The frequency of cerebral palsy in term births is 1.5–2 per 1000 live births.13
There are many causal pathways to CP in the term or near term infant13 several of which include NE (see Table 1).
The outcomes following these different pathways vary from death to CP to normal development and the outcome
Consensus statements
Consensus statements, based on the best evidence available at the time, were developed to assist clinicians and researchers in determining whether an intrapartum asphyxia event was likely to have caused brain damage.
The consensus statement of the Australian and New Zealand Perinatal Societies was first published in MJA 1995.26 It states that there is no clear evidence that obstetric technologies to avoid or reduce fetal distress, in particular EFM and caesarean section, have reduced the
Compensation and long term care
Learning that one’s child has CP is distressing for parents, particularly when they realize that the condition is long-term and will significantly affect the development of their child, in all but very mild cases. The ongoing financial cost brings further stress. The Australian Medicare system provides for basic medical and allied health care, but the cost of regular therapy and education beyond the Medicare allowance is prohibitive for many families. The option of pursuing a legal path for
Conclusion
Due to the extensive work done by the International Task Force we now have criteria in the international consensus statement that can be applied by experts who provide opinion concerning the association between CP and intrapartum events.
There is still work to be done in relation to compensation for the long-term care of CP patients and others with severe/profound disabilities. This challenge, like that of the Task Force, requires consultation with various agencies, including government and
References (30)
- et al.
Defining the pathogenesis and pathophysiology of neonatal encephalopathy and cerebral palsy
Obstetrics Gynecol
(2003) - et al.
Origin and timing of brain lesions in term infants with neonatal encephalopathy
The Lancet
(2003) Cerebral palsy and thrombi in placental vessels of the fetus: insights from litigation
Hum Pathol
(1997)Intrapartum asphyxia and cerebral palsy: is there a link?
Clin Perinatology
(2006)- et al.
The cerebral palsies in Western Australia: trends, 1968 to 1981
Am J Obstetrics Gynaecol
(1988) - et al.
Fetal Monitoring: is it worth it?
Obstetrics Gynecol
(1975) - et al.
Projections of Australian obstetricians ceasing practice and the reasons
MJA
(2002) - et al.
Who will deliver our grandchildren? Implications of cerebral palsy litigation
JAMA
(2005) - Loane Skene, Law & medical practice. 2nd ed. Butterworths. 10 [Chapter...
- et al.
Relation between negligent adverse events and the outcomes of medical-malpractice litigation
New Engl J Med
(1996)
A report: the definition and classification of cerebral palsy
Dev Med Child Neurol
Birth injury and the obstetrician
Recent Adv Obstetrics Gynaecol
Diagnosis, treatment and prevention of cerebral palsy
Clin Obstetrics Gynecol
The Epidemiology of cerebral palsy in term infants
Ment Retard Dev Disabilities Res Rev
A research definition for ’Birth Asphyxia’?
Dev Med Child Neurol
Cited by (21)
Ischemic hypoxic encephalopathy: The role of MRI of neonatal injury and medico-legal implication
2021, Forensic Science InternationalCitation Excerpt :In addition to allowing the identification of the damage, the neuroradiological data allows to characterize the nature and extent of the damage itself. The acquisition and evaluation of the MRI exam are, in fact, one of the key points for the coroner to define a possible involvement of the obstetrician-gynecologist in the poor management of childbirth [11]. There is a large debate in the literature about the correct timing of MRI study in infants with suspected hypoxic-ischemic encephalopathy.
Claims about medical malpractices resulting in neonatal and maternal impairment in Iran
2019, Journal of Forensic and Legal MedicineCitation Excerpt :Mahmoodian et al. (2012) showed that of 7 medical malpractice claims, 5 were against physicians at the top while midwives received the second most frequent complaints among non-physicians, compared to other health service providers.13 Society's expectations have increased of this specialization21 in line with its advances.22 The smallest violation of scientific standards may cause dangerous and mortal complications in this field, as unlike other groups of medical specialists, obstetricians and midwives should oversee two lives and two human-beings rather than one, and any error can lead to death or permanent injuries in the mother, the fetus or both.23
Threshold of metabolic acidosis associated with newborn cerebral palsy: medical legal implications
2019, American Journal of Obstetrics and GynecologyCitation Excerpt :Although birth asphyxia-induced cerebral palsy has been associated with neonatal encephalopathy, alternative disorders that include brain malformations, fetal growth restriction, and placental diseases may manifest as neonatal encephalopathy. Furthermore, prematurity,29,30 perinatal infections, prelabor hypoxic events, perinatal stroke,31 congenital or metabolic abnormalities, and neonatal hypoxia or hypoglycemia may or may not exhibit neonatal encephalopathy.32 Thus, it is often challenging to definitively assign a hypoxia-associated cause for neonatal encephalopathy.
Study of financial compensation in rulings against obstetricians and gynaecologists in Spain (1987-2013)
2017, Revista Espanola de Medicina LegalAnalysis of court claims filed against obstetricians and gynaecologists in Spain. Specific study of the criminal court system (1987-2013)
2016, Revista Espanola de Medicina LegalIntrapartum asphyxia: Risk factors and short-term consequences
2016, Journal de Gynecologie Obstetrique et Biologie de la Reproduction