Our attorneys see a lot of parents calling us believing their child was harmed by chorioamnionitis who are trying to find out if they have a birth injury claim. Chorioamnionitis is a bacterial infection of the fetal membrane and amniotic fluid during pregnancy. A chorioamnionitis infection occurs when vaginal bacteria transfer into the uterus and spread. Chorioamnionitis occurs in approximately 2% of all childbirths in the U.S. It can have a number of adverse effects during pregnancy. A chorioamnionitis infection can block or limit the mother’s ability to pass nutrients to the baby.
If chorioamnionitis is not properly diagnosed and addressed the infection can also spread to the baby resulting in permanent long-term birth injuries such as hypoxic-ischemic encephalopathy, cerebral palsy. How does it cause a brain injury? Chorioamnionitis causes an inflammatory response of cytokines that targets specifically the periventricular white matter in the premature infant, causing periventricular leukomalacia or PVL. The periventricular white matter is particularly sensitive to damage. It is also important to remember that chorioamnionitis is known to cause utero placental insufficiency and to compromise the ability of the placenta to oxygenate the fetus. Most birthing process brain injuries involve oxygen deprivation.
Chorioamnionitis can also cause premature labor and delivery which can lead to a host of complications for the mother and child.
What Causes Chorioamnionitis?
Chorioamnionitis is a well-recognized cause of preterm labor, preterm rupture of membranes and preterm delivery. Like any infection, chorioamnionitis results from the growth and spread of unwanted bacteria. In the case of chorioamnionitis bacteria in the mother’s vagina or colon travels upward to the uterus and eventually infects the amniotic fluid and fetal membrane. When the amniotic sac remains intact this type of infection is less likely. When the amniotic sac ruptures prematurely (“water breaking”) before delivery it creates a higher risk of chorioamnionitis infection. Other conditions which increase the risk of chorioamnionitis include prolonged labor after water breaks, Group B strep, urinary tract infections during pregnancy, and a short cervix.
How is Chorioamnionitis Diagnosed?
Diagnosing chorioamnionitis is similar to diagnosis of other infections. Initial suspicion of chorioamnionitis is based on clinical symptoms in the mother. Symptoms of chorioamnionitis include maternal fever, fetal tachycardia (160 or higher fetal heart rate), elevated heart rate in the mother, foul-smelling vaginal discharge, and elevated white cell count in the maternal blood.
Preterm premature rupture of the membranes places a pregnancy at greatly increased risk for chorioamnionitis as microorganisms can ascend through the cervix to infect the amniotic fluid, now unprotected by the breached amnion. Preterm premature rupture of the membranes can also result from chorioamnionitis. The primary indicator of chorioamnionitis is if the mother has an elevated fever.
Visible abnormalities in the placenta or uterine cord can also be signs of chorioamnionitis. In some cases, however, there may actually be no overt symptoms of chorioamnionitis. Diagnosing chorioamnionitis is usually done based only on clinical symptoms because sampling the amniotic fluid or membrane is often not viable. If necessary, an ultrasound-guided needle aspiration of the amniotic fluid can be performed and the fluid tested for bacteria. Early recognition of risk factors for chorioamnionitis is also an important part of diagnostic efforts.
Treatment and Management of Chorioamnionitis
Chorioamnionitis can be a very dangerous condition. Proper treatment and management of the condition are therefore very important. Treatment almost always involves administering antibiotics to combat the infection. The other option is to perform an emergency c-section delivery. This is often a preferable path to allowing the fetus to languish in a hostile environment for hours.
Failure to Treat Chorioamnionitis
If not properly diagnosed and effectively treated, chorioamnionitis can have very serious consequences for both mother and baby. Untreated chorioamnionitis can lead to a blood infection known as bacteremia. It can also cause pneumonia. Chorioamnionitis can also result in brain and nerve injuries such as cerebral palsy. In rare cases, chorioamnionitis can result in meningitis which often causes long-term disability and even death.
If a mother has chorioamnionitis as an infection in the placenta, it is between 5 and 9 times more likely that the baby will be born with cerebral palsy.
Medical Malpractice Claim for Failure to Diagnose / Treat Chorioamnionitis
If your doctors or the delivery staff at the hospital fail to properly diagnose and treat chorioamnionitis they can be liable for medical malpractice. The question in these cases is whether the doctor and delivery team properly monitored for signs of infection so as to promptly diagnose chorioamnionitis and treat it. Sometimes this issue can get tricky when the infection presents during labor and delivery. When the mother is in the middle of labor the doctors obviously don’t have time to do lab work and confirm a chorioamnionitis diagnosis. They have to rely on clinical symptoms and their own professional judgment.
Verdicts & Settlements for Chorioamnionitis Malpractice
Below are summaries of recent verdicts and reported settlements for malpractice claims based on failure to diagnose or treat chorioamnionitis.
- Madden-Buck v. Maimonides Med. Center (2017 New York): $26 million verdict. Plaintiff alleged that her doctors failed to timely recognize that she had a short cervix, which increased the risk of fetal infection. By the time this condition was discovered infection had already occurred and it was too late to properly treat. Plaintiff gave birth early to twin girls. One of the babies died from chorioamnionitis shortly after birth and the other baby was born completely deaf and with damaged vocal cords.
- R., Pro Ami v. NYC Health & Hosp. Corp. (2015 New York): $750,000 settlement. Plaintiff alleged that doctors failed to timely perform emergency c-section delivery in response to clear signs of chorioamnionitis. The baby suffered cerebral palsy as a result.
Typical Chorioamnionitis Defense
Defense lawyers in these cases argue that most term infants who are exposed to chorioamnionitis have an uncomplicated neonatal course and neurological outcome, and histological chorioamnionitis does not appear to increase the risk of adverse outcome. There are a lot of qualifier in that statement. And the premise is suspect — there is medical literature going the other way. But you can expect to hear this in almost every chorioamnionitis case in discovery and at trial.
The doctor’s attorneys will also argue that the brain injury caused by chorioamnionitis happens earlier in the pregnancy when there is a greater risk to the white matter in the brain.
Contact Miller & Zois About Chorioamnionitis Malpractice
Birth injuries resulting from failure to treat chorioamnionitis. If your child has suffered a birth injury, my law firm can help you. Call me today at 800-553-8082 or get a free online case evaluation.