There are countless potential complications to consider in any pregnancy. One condition that affects both mother and child is chorioamnionitis, an often-missed infection that can occur prior to or during labor. Chorioamnionitis is the culprit in half of all preterm births and more than a third of stillbirths involve chorioamnionitis.
While treatable, this illness can have deadly serious consequences if not properly diagnosed during a pregnancy. Immediate and long-term effects of chorioamnionitis for the baby include fetal mortality, neonatal intensive care admission, chronic lung disorders, and cerebral palsy. Here are the important facts you need to know.What is Chorioamnionitis?
Chorioamnionitis is a bacterial infection of the amniotic fluid and the membranes surrounding the fetus (the outer membrane known as the chorion and the fluid-filled sac known as the amnion). When bacteria - such as E. Coli -- present in the vagina travels toward the uterus, it may develop into a severe infection affecting both the mother and her fetus. Symptoms of chorioamnionitis can include a fever, discolored/foul-smelling vaginal discharge, and an unusually quick heartbeat. Those at risk for the condition include first time mothers, pregnant women under 21 years old, and women who are experiencing an unusually long labor. Although most commonly seen in preterm births, chorioamnionitis can also occur in full-term births.
Chorioamnionitis causes an inflammatory response of cytokines that are cell signaling molecules. This inflammatory response targets the periventricular white matter in the fetus, causing periventricular leukomalacia or PVL. The periventricular white matter is highly vulnerable to injury between the gestational age of 23 and 32 weeks. White matter is crucial for all of us and damage to it causes a host of maladies, including It is this damage to the white matter the cause of the cerebral palsy.What Causes Chorioamnionitis?
Chorioamnionitis is caused by a bacterial infection. This infection usually begins in the birth mother's vagina.How Does This Affect You and Your Child?
For pregnant women, chorioamnionitis carries a host of potentially serious complications. These include excessive bleeding during delivery, blood clots in the pelvis or lungs, and an increased likelihood of Caesarean delivery. Chorioamnionitis can cause fetal mortality, neonatal intensive care admission, chronic lung disorders, and cerebral palsy.
Chorioamnionitis occurs in up to 2% of births in the United States. Chorioamnionitis is responsible for approximately half of all preterm births. The condition can also cause a bacterial blood infection (known as bacteremia) in up to 12% of women with the chorioamnionitis. For the fetus, an untreated chorioamnionitis infection may result in bacteremia or pneumonia. In rare cases, the condition can cause meningitis leading to developmental disability, deafness or death.
What happens in cases where chorioamnionitis leads to a malpractice lawsuit? The chorioamnionitis is an infection of the outside of the placenta, and that infection may transfer to the baby. If the chorioamnionitis is ignored, the baby's response of producing cytokines to fight the infection can harm the baby. But obstetricians often do not get too worked up about chorioamnionitis because it is often benign. This lures the doctor into a false sense of security until it is too late to avoid the negative impact of chorioamnionitis on the infant.How Can It Be Treated?
Preventative care is key during your pregnancy: This includes appropriate bacterial screenings and keeping invasive vaginal examinations at a minimum. Immediate treatment for chorioamnionitis is crucial in order to reduce a patient's fever and diminish the likelihood of infection or birth complication for the fetus. Expectant mothers are commonly placed on intravenous antibiotics, including penicillin and gentamicin. While chorioamnionitis is a serious condition, it rarely compromises future fertility and does not usually require outpatient treatment after discharge.Sample Verdicts and Settlements in Chorioamnionitis Cases
Below are just a handful of examples of the catastrophic toll this condition can take during pregnancy. There is not a defined settlement value of chorioamnionitis birth injury claims. These cases are rare and, ultimately, the key is the injuries to the child and whether the obstetrician or pediatrician could have solved the problem if he had properly diagnosed the concern.
The key for the obstetrician and pediatricians is clinical observation and getting prompt and accurate labs. You also need to see when a child is in distress during the birthing process. Clearly, you want to avoid giving a child antibiotics whenever you can. But there comes a point where a reasonable doctor has to act to protect the child from sepsis and brain injuries by delivering the child quickly (usually by C-section) or to deliver antibiotics when the infection is threatening the mother or child.
With respect to the failure to perform a Caesarean section, defense lawyers for obstetricians argue that there is support for the argument that chorioamnionitis alone is not cause for a C-section. Defense lawyers also argue that in real time an obstetrician is able to make a diagnosis of chorioamnionitis based only on presenting clinical information and does not have the hindsight benefit of placental pathology. This might be true. But the reality is that if the baby does suffer an injury, the likelihood is that if you look at the fetal heart monitor strips, you will find a baby that was clearly in distress. If chorioamnionitis is thought to be the cause of an abnormal fetal heart rate tracing, the standard of care requires the removal of the fetus. Most successful chorioamnionitis medical malpractice lawsuits involve the allegation that the doctor should have delivered the baby soon.
Another issue in these cases is Pitocin. This is a drug that is meant to accelerate delivery. Where there is a change in the fetal heart rating tracing to tachycardia - especially if there is a maternal fever or a suspicion of chorioamnionitis, the Pitocin should be turned down. If chorioamnionitis is a suspected cause of fetal tachycardia, repeated hyperstimulation will further compromise the baby.
- New York 2017 - $26,000,000 verdict: Pregnant mother alleged that doctors and hospital negligently failed to recognize that she had a short cervix (which increases risk of fetal membrane infection) and then failed to timely diagnose chorioamnionitis. Delay in the diagnosis of infection prevented effective treatment in time to prevent harm to her twins. She delivered prematurely. One of the twins died from infection days after birth. The other twin survived but the infection left her permanently deaf and damaged her vocal cords. The jury awarded $26 million in damages.
- New York 2015 - $750,000 settlement: Baby was born with an infection that caused moderate cerebral palsy. He sued hospital and doctors claiming that they breached the standard of care by failing to timely recognize symptoms of chorioamnionitis and perform an emergency C-section in response. Claim settled for $750,000.
- Michigan 2015 - $3,500,000 settlement: Thirty-one weeks into her pregnancy, a woman was hospitalized for an infection. The mother was discharged but re-admitted twice when her symptoms worsened. After the child was delivered, it was determined that the newborn suffered from epilepsy, cerebral palsy and cortical blindness. In their suit, the plaintiffs alleged that the health care providers' failure to properly consider records from the mother's three separate hospital admissions. They alleged these records demonstrated that the mother had developed chorioamnionitis arising from an untreated vaginal/cervical infection. The plaintiffs held that the child should have been delivered sooner to prevent injury to the fetus. They cited a pathologist's examination, which confirmed that an infection had spread from the placenta to the umbilical cord. The defense denied any departure from the standard of care in their actions. During the trial, the parties agreed to a settlement.
Getting Help for Your Chorioamnionitis Claim
The issue in this cases is whether the doctor breached a standard of care by not ordering the antibiotic Gentamicin during the intrapartum period. If you believe your child has suffered a birth injury that could have been prevented if the doctor had met that standard of care, you may have a medical malpractice lawsuit. You and your child may be entitled to receive financial compensation. We can help you determine your options. If you think your child may have been negligently harmed by a doctor or nurse's mistake, call us at 800-553-8082 or get a free online consultation.