Claimant was born and is therefore now 7 years old. He brings this claim for damages for personal injuries and consequential losses allegedly sustained as a result of the negligent management of his mother’s labour and birth. [1]
D admits breach of duty in the management of the labour, it denies that any of C’s injuries are a consequence thereof. [2]
M’s pregnancy proceeded routinely and there were no concerns about fetal growth [12]
On 16 September 2016 (at 41 weeks + 2 days’ gestation) M was admitted to the delivery suite with a history of antepartum haemorrhage at home. [13]
normal vaginal delivery occurred following which the placenta delivered. C was described as having a good heart rate of greater than 100 beats per minute (“bpm”). However he was not breathing.[13q]
Cord blood pH [4] readings were recorded at birth, with an arterial pH of 6.92 and a venous pH of 7.23. [13n]
C’s case is that the D’s admitted breach of duty managing M’s delivery of him, namely the administration of Syntocinon caused or materially contributed to him developing a hypoxic ischaemic encephalopathy 12. The HIE in turn was either the sole cause of or was a material contributor to C’s current developmental delay. [15]
D contends that either C did not suffer HIE, but rather other neonatal insult or that, even if he did suffer HIE, that was caused not by the admitted breach of duty but by other factors. In any event, D denies that C’s current developmental delay can be attributed to HIE. [16]
central issues in the case are:
- Whether C suffered HIE;
- If he did suffer HIE, whether that was caused by D’s admitted negligence;
- If he suffered HIE caused by D’s admitted negligence, whether that was a cause of his developmental delay and/or any other injury for which damages are recoverable. [17]
The administration of Syntocinon is admitted to have been negligent – there was evidence of tachysystole (excessive uterine activity), potentially attributable to the antepartum haemorrhage and/or a small placental abruption.[19]
C argues that the court can be satisfied on the balance of probabilities that, whilst a period of acute hypoxia may have contributed to his neonatal condition, there was an earlier period of chronic hypoxia, consequent on uterine hyperstimulation, which contributed to the C’s condition at birth and his subsequent developmental problems. [22]
D argues that the progress of the labour as evidenced by the CTG trace, C’s condition at birth and his subsequent constellation of difficulties are not consistent with the mechanism of chronic hypoxia but rather have other explanations. In particular, C’s neonatal condition was suggestive of stroke; and his retinal dystrophy and microcephaly are suggestive of a genetic syndrome which, whilst as yet unrecognised, is the probable cause of some or all of C’s difficulties. [23]
the course of C’s delivery, his neonatal state, his longer term outcome and the available objective signs do not hang neatly together to produce a coherent picture. [27]
C shows that he suffered HIE as a result of D admitted breach of duty, he cannot show on the balance of probabilities that he has suffered anything other than the immediate depression of his condition at birth as a result of the HIE. [139a]
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