Athetoid Cerebral Palsy Case Study - G

Helen Niebuhr acts for G and his family.

G was born on 2nd March 1988.

On 29.02.1988, G's mother was admitted to the John Radcliffe Hospital, Oxford at 40 weeks gestation with pre-eclampsia.

On 01.03.1988 at 15.30 G's mother experienced spontaneous rupture of her amniotic sac releasing meconium stained fluid.

G's mother was transferred to the delivery suite. She was recruited to a study being carried out by a research registrar employed by the Defendants, which involved monitoring throughout labour.

At 17.50 G's mother was reviewed by the specialist registrar.  Syntocinon infusion (to augment contractions) was begun at about 18.35 hours.

From the time of the first examination, G's mother's labour was supervised and managed personally and exclusively by the research registrar.

On 02.03.1988 from 00.10 the CTG trace recording (of G's heart rate and his mother's frequency of contractions) became suspicious with a rise in the baseline rate and reduced baseline variability.  The trace also showed late decelerations.

At 02.00, the registrar performed a vaginal examination finding the cervix 6 cm dilated and the foetal head was not engaged. By this time, syntocinon had been administered for 7 ½ hours.

At 02.40 an epidural block was sited.

At 02.45 deep decelerations of the foetal heart were noted.

At 03.45 it was noted that the decelerations had recovered.

At 03.50 deep decelerations reoccurred. At this time, the bradycardia was severe, from a baseline of 140 bpm to a flat nadir of about 65 bpm where it remained for 2 minutes. The baseline of 140 bpm did not recover for 5 minutes.

At 03.55 G's mother was given an epidural top up.

Between 04.00 and 04.10, the CTG showed deep decelerations and no accelerations.

At 04.10 another episode of bradycardia occurred. The nadir of the deceleration was 65-70 bpm and lasted more than 3 minutes. It was associated with uterine hypertonus. The baseline did not recover for almost 10 minutes.

At 04.40 syntocinon was re-introduced.

Further decelerations and evidence of hypertonus showed on the CTG.

At 06.00 the cervix was fully dilated. At this time, there were persistent late decelerations.

At 06.45, the syntocinon dose was increased.

At 08.10, maternal pushing began and decelerations returned and became deeper. The baseline rate increased to 160 bpm and variability reduced. The CTG was abnormal.

At 09.20 the registrar applied Kiellands forceps. He failed to achieve rotation of the head due to attempting to turn it in the wrong direction.

The registrar applied Neville Barnes forceps without success. He then reapplied the Kiellands forceps, attempted rotation of the head in the other direction and delivered the Claimant.

The Claimant was born in a very poor condition, effectively stillborn.

Apgar scores were 1 at 1 minute with a detectable heartbeat of 6-12 per minute which became undetectable. Cardiac massage was started. Apgar was 2 at 5 minutes and at 20 minutes. External cardiac massage continued for 22 minutes.

Cord blood gas samples at 1 hour of age showed artery - pH 7.01 base deficit 19, vein - pH 7.2, base deficit 14.6.

The onset of regular breathing began at 30 minutes.

Within 1 hour of admission to the Special Care Baby Unit Graham began to have seizures.

He showed characteristics of Hypoxic Ischaemic Encephalopathy.

He had marked bruising, forceps marks and swelling to the head and face with a depression in the left frontal region thought to be a fracture.

A CT scan showed evidence of brain swelling, hypoxic/ischaemic injury and subarachnoid haemorrhage.

G has been from birth severely and permanently handicapped. He sustained severe brain damage and is diagnosed as having spastic dystonic cerebral palsy.

G is unable to walk and is confined to a wheelchair. He cannot and never will be able to care for or feed himself. He us unable to speak save for occasional words, yes and no. He uses computer assisted communication aids and has some insight into his condition.

G requires assistance with all daily activities and personal hygiene. He is not expected to be capable of any form of employment and will require 24 hour care for the rest of his life.

It was G's case that from 04.30 the proper management decision was to deliver G immediately by caesarean section.

There were a total of 29 allegations of negligence made by on G's behalf.

It was G's case that delivery even 10 minutes earlier would have avoided his brain injury and cerebral palsy.  

The Defendants admitted responsibility for G's injury.  

Judgment was entered and compensation agreed (on the first day of the trial) at £3,125,000.