By a claim form issued on 4 April 2023, C brought a claim for damages arising from the alleged negligence of D during April/May 2016, resulting in bilateral, four-limb cerebral palsy. [1]
C was born on 10 May 2016… After an uneventful early pregnancy, the C’s mother (‘M’) attended the hospital on 25 April 2016, when she was 27 weeks plus 5 days gestation. She reported leaking clear fluid. It is now agreed that there was pre-term, pre-labour rupture of membranes (‘PPROM’) and that chorioamnionitis developed during the 12 to 24 hours before C’s presentation on 10 May. This resulted in an ascending maternal amniotic infection which triggered pre-term labour, funisitis, a foetal inflammatory response which in turn led to periventricular leukomalacia. [2]
It is also agreed that there were opportunities to decide to offer and administer antibiotics between 26 April and 10 May and that there were negligent omissions in that regard. In large measure, this case is concerned with the evidence and issues of causation of the cerebral palsy. The evidence and submissions focussed on the roles and effectiveness of antibiotics, and combinations of antibiotics. Those roles included the suppression of particular bacteria and the microbiome in the genital tract, potential infection of the chorion, inflammation, and consequential impacts on the development of the baby’s brain. [3]
C’s primary case was to be based on the ‘but for’ test for causation, with a subsidiary case based on material contribution, in that the Defendant’s negligence made a more than minimal contribution to the neurological injury. [4]
D’s case is that chorioamnionitis of the same severity and duration would always have been suffered, with the same inflammatory response, the contributory factors to which are not well understood. It is misconceived and wrong to elide the issue of material contribution to risk of injury, with material contribution to injury. [5]
The low vaginal swab isolated GBS on 28pril 2016 and on 30th April 2016 GBS resistance to Erythromycin and sensitivity to penicillin was identified. No antibiotics were administered. [21]
On 28 April the C-reactive protein result was normal. D was in no doubt that membranes had not broken and that M could be discharged. [22]
M returned to hospital on 4, 7 and 9 May when she was told that there were no signs of infection. On 4 May, D noted that M was positive for GBS and ‘Amnisure positive’. This indicated loss of amniotic fluid. Her impression was of PPROM [24]
On 10 May, M was admitted… the impression of early labour. C-reactive protein remained normal. At 1350 M’s temperature was 38.3 degrees. She was given paracetamol, gentamicin, amoxicillin and penicillin between 1402 and 1440. Claimant was born at 1805 at “29 + 3 weeks” [25]
The infection which caused the chorioamnionitis only developed in the 12 to 24 hours prior to delivery of C [26]
The placental membranes were yellow and there was acute inflammation in the walls of both the umbilical artery and umbilical vein and the membranes showed acute chorioamnionitis. The diagnosis was of recent ascending amniotic infection which was a secondary complication and not the cause of the membrane rupture. The placenta swab grew no organisms. [27]
C’s case is that by reason of D’s (admitted) failure to prescribe and administer prophylactic antibiotics following a diagnosis of PPROM, M developed chorioamnionitis some 12-14 hours prior to delivery at 1805 on 10 May which she otherwise would not have done, and which chorioamnionitis caused C to succumb to a foetal inflammatory response which caused her severe brain damage (PVL), which has given rise to a biplegic cerebral palsy. That case is advanced on the basis of Erythromycin alone and also Erythromycin in combination with penicillin. If either of those courses had been taken, labour would have been prolonged so as to avoid chorioamnionitis or reduce its severity in a material way, particularly as to the foetal inflammatory response. [44]
…it has not been shown on the balance of probabilities that a combination of antibiotics, including penicillin, would have prevented the Claimant’s injury and causation has not been shown on this basis. [167]
the claim must therefore be dismissed [172]
medicalnegligencenow.com 