Spastic Quadriplegic Cerebral Palsy Case Study - IA

Helen Niebuhr acts for IA and his family.

IA was born 9 days before his due date. During the last hour and a half of labour he suffered from intermittent lack of oxygen. This caused him severe brain damage.

IA suffers from spastic quadriplegic cerebral palsy, microcephaly, severe mental retardation, and severe visual impairment. He has difficulty swallowing and is fed via a gastrostomy.

Following investigation the hospital accepted that the treating doctors had failed to properly manage Mrs A's labour. Signs of increasing risk of brain injury were ignored. Labour was allowed to continue when the doctors should have intervened and delivered IA an hour and a half earlier.

The hospital accepted that had IA been delivered when he should have been he would not have suffered any injury and would be able to live a normal life.

In December 2001 aged 23 Mrs A became pregnant for the first time. Her pregnancy was largely uncomplicated with routine antenatal screening and appointments being nothing but reassuring. 11 days before her due date Mrs A was assessed at hospital as she reported a show (loss of cervical plug and possibly amniotic fluid). The babies heart rate was monitored and was normal.

The next day, 10 days before her due date, Mrs A was admitted to hospital following onset on contractions and obvious draining of amniotic fluid. The babies heart rate was monitored and noted to be normal. 26 hours after admission to hospital vaginal examination was recorded as showing 2 cm of cervical dilatation.

Labour was augmented by Syntocinon (a synthetic version of the hormone Oxytocin which stimulates uterine contraction). The babies heart rate was recorded as rising from 130 beats per minute.

7 hours after commencement of Syntocinon full dilatation was recorded (10 cm cervical dilatation). By this time the babies heart rate had risen to 180 beats per minute and started to show some significant sudden drops followed by slow recovery. 45 minutes after full dilatation Mrs A was encouraged to commence pushing.

After an hour's pushing and episiotomy was performed and delivery achieved shortly thereafter.

Mrs A was developed a fever during labour and was given paracetamol. Examination of the placenta after delivery showed infection (chorioamniotitis) by Group B Streptococcus.

IA was born in a poor condition and required resuscitation. He was transferred to the Special Care Baby Unit (SCBU) where he developed respiratory distress syndrome and seizures. He went onto develop a severe four limb motor disorder, microcephaly, and demonstrate severe visual impairment and cognitive injury.

IA is now aged 6 years. He is totally dependant on his parents for all aspects of daily living. He is fed via a gastrostomy, has very limited independent movement and communication.

We investigated the care Mrs A received during pregnancy, labour, and delivery.

Our obstetric expert believed that there were clear signs during labour that the baby was at increasing risk of injury and that these signs were not properly taken into account by the treating doctors. The babies heart rate had risen gradually during the time that labour had been augmented with Syntocinon from 130 beats per minute (bpm) to 180 bpm.

Further that having risen to 180 bpm the heart rate showed regular substantial drops following uterine contractions. Our obstetric expert believed that the treating doctors should have recognised that the babies heart rate was showing he was at increasing risk of brain damage due to intermittent lack of oxygen. The doctors should have ensured that he was delivered either vaginally or by caesarean section an hour and a half before eventual delivery.

Views were obtained from a paediatrician, paediatric neuroradiologist, and neonatologist which confirmed that the babies brain injury occurred during the last hour of labour.

The case was put to the hospital which after investigation accepted that the treating doctors had negligently failed to act on signs that the baby was at increasing risk of brain injury and that had the doctors acted properly Mrs A's baby would have been born uninjured.

IA's needs are being assessed and steps put in place to ensure that his family are able to provide for all his needs for life. The family will need to move to a house suitable for adaptation to provide an environment to meet IA's needs and need assistance in ensuring that his physical, educational, and other needs are properly met.