Medical Malpractice
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 that can sometimes lead to medical malpractice lawsuits.
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, sepsis, and cerebral palsy and other birth injuries.
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.
What Are the Symptoms of Chorioamnionitis?
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 cerebral palsy.
- Frequently asked questions about chorioamnionitis
What Causes Chorioamnionitis?
Chorioamnionitis is caused by a bacterial infection. This infection usually begins in the birth mother’s vagina.
How Does Chorioamnionitis Affect You and Your Child?
- excessive bleeding during delivery
- blood clots in the pelvis or lungs, a
- an increased likelihood of Caesarean delivery.
Chorioamnionitis can cause fetal mortality, neonatal intensive care admission, chronic lung disorders, and cerebral palsy.
How Common is Chorioamnionitis?
What Happens When Chorioamnionitis Leads to a Malpractice Lawsuit?
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.
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 appears benign. This lures the doctor into a false sense of security. So the doctor ignores the guidelines until it is too late to avoid the negative impact of chorioamnionitis on the infant or mother.
How Is Chorioamnionitis 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 c
linical 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, if you look back at the fetal heart monitor strips, you will likely 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.
Illinois 2019 – $2,100,000 settlement: A woman delivered her stillborn daughter a day after she presented to the hospital. She hired an attorney who filed a lawsuit alleging the hospital and the doctors failed to order an emergency C-section and failed to diagnose and treat her chorioamnionitis and her daughter’s fetal tachycardia. She also argued that her daughter would have survived if the obstetrician ordered an emergency C-section. This case settled for $2,100,000.
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. The mother and child hired a birth injury lawyer and filed a lawsuit, alleging the health care providers’ failed to consider records from the mother’s three separate previous 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.
Chorioamnionitis FAQs
What Causes Chorioamnionitis?
As with any infection, the proximate cause of chorioamnionitis is the growth and spread of harmful bacteria. The risk of this condition developing increases with prolonged labor, as well as a premature rupture of the amniotic sac (“water breaking”) before delivery, higher numbers of vaginal examinations in the final month of pregnancy, Group B strep, a short cervix, and/or urinary tract infections during pregnancy.
What Are the Signs and Symptoms of Chorioamnionitis?
Before delivery, chorioamnionitis is diagnosed because of maternal fever and at least two of the following additional symptoms:
- Maternal leukocytosis (high white blood cell count greater than 15,000)
- Maternal or Fetal tachycardia (heartbeat over 100 bpm)
- Uterine tenderness
- Diaphoresis (excessive sweating)
- Vaginal discharge
- The foul odor of the amniotic fluid
For infants, a diagnosis is typically made based on the following symptoms:
- Weak cries, poor sucking, and fatigue
- Pulmonary problems, such as respiratory distress, apnea, and cyanosis
- Gastrointestinal problems, which may include bloody stools, vomiting, and diarrhea
- Seizures
- Hematologic problems, such as pallor or purpura
How Is Chorioamnionitis Diagnosed?
Chorioamnionitis can be diagnosed through various methods, including amniotic fluid culture, Gram staining, or a combination of both, along with biochemical analysis.
However, in most cases involving postpartum individuals, the diagnosis relies primarily on clinical evaluation of symptoms and signs. Chorioamnionitis or intraamniotic infection is categorized upon diagnosis into three distinct groups:
- Isolated Maternal Fever (not Triple I): In this category, a pregnant person has a fever, but it is not necessarily indicative of a full-blown intraamniotic infection (Triple I). It means there is an isolated elevation in the mother’s body temperature, which may or may not be associated with an infection in the amniotic fluid or membranes. It’s a milder form of chorioamnionitis.
- Suspected Triple I: This category suggests a suspicion of a more severe condition known as “Triple I,” which stands for “Intraamniotic Infection and Inflammation.” It implies that some signs and symptoms strongly indicate the presence of an infection or inflammation within the amniotic sac and membranes, but it hasn’t been confirmed definitively through diagnostic tests yet. Healthcare providers are concerned about the possibility of Triple I.
- Confirmed Triple I: This is the most severe category. It means that diagnostic tests or clinical findings have confirmed the presence of an intraamniotic infection and inflammation (Triple I). In this case, there is clear evidence of an infection or inflammation within the amniotic sac, which can pose significant risks to the mother and the developing fetus. It often requires immediate medical attention and intervention.
What Kind of Complications Can Arise From Chorioamnionitis?
If a case of chorioamnionitis isn’t adequately treated or is especially severe, some of the possible complications for the mother include:
- Endometritis (infection in the uterus lining)
- Sepsis (blood infection)
- Abdominal or pelvic infection
- Blood clots in the pelvis or lungs
Complications for your child can include sepsis, respiratory problems such as pneumonia, and meningitis (infection of the spinal cord and brain). Chorioamnionitis is also a risk factor for developing brain complications such as cerebral palsy, periventricular leukomalacia, and premature birth.
Other complications that can develop include villitis, hypoxic-ischemic encephalopathy (HIE), funisitis, hydrops fetalis, and intrauterine growth restriction (IUGR).
Although some of these conditions – such as funisitis and villitis – are usually benign, they can increase the risk of stillbirth and fetal death. Due to the risk or presence of these complications, chorioamnionitis may also warrant neonatal intensive care admission.
It is important to note all of these infections are more likely to develop and become fatal for premature babies. However, the risks are still relatively rare in these cases, with around a 15% chance of brain complications and a 10-20% chance of developing pneumonia.
Can Chorioamnionitis Cause Stillbirth?
Unfortunately, chorioamnionitis can result in stillbirth in the most severe cases. Although this will only rarely happen if promptly diagnosed and treated, in some cases, such as when chorioamnionitis occurs earlier in pregnancy and is asymptomatic, stillbirth can be more likely.
In addition, the risk of stillbirth may be increased by the development of complications such as funisitis, infection, and umbilical cord inflammation.
Although chorioamnionitis does not usually result in stillbirth, it is one of the most common causes, with one study finding that 37% of stillbirths were linked to the condition.
What Is the Treatment for Chorioamnionitis?
Treatment for chorioamnionitis typically involves the prompt administration of intravenous antibiotics, which have a high rate of aiding successful recovery in cases such as a group B strep infection.
In other cases, treatment may require immediate delivery of the baby. Either way, antibiotics are commonly prescribed for both the mother and her child after delivery, usually for a day or two.
Supportive measures such as the use of acetaminophen (Tylenol) can also be significant during delivery to help prevent the occurrence of brain damage (but you also have to consider the possible acetaminophen/autism or ADHD concern).
In addition to antibiotics, some additional forms of treatment may include:
- Infant intubation and ventilation
- Balancing glucose levels
- Artificial breathing tubes for the infant
In severe cases, surgery may also be necessary for your child if any of these symptoms are present:
- Subcutaneous (beneath the skin) or brain abscess
- Infections around the pleural area (of the lungs)
- Severe abdominal infections
- Bone and/or joint infections
Is there an increased risk that the child will be born with cerebral palsy if the mother has chorioamnionitis?
If a mother has chorioamnionitis as an infection in the placenta, there is as much as ten times greater risk that the child will be born with some cerebral palsy.
What is the Difference Between Histological Chorioamnionitis and Clinical Chorioamnionitis?
If chorioamnionitis is diagnosed based on the mother or child’s symptoms, it is clinical chorioamnionitis. Histological chorioamnionitis is diagnosed by looking at the placenta. So if the mother has no symptoms, but the doctors later put the placenta and look under the microscope, they find chorioamnionitis, that’s histological chorioamnionitis.
What are the ACOG Recommendations for Treating Chorioamnionitis?
The American College of Obstetricians and Gynecologists (ACOG) is an educational resource to aid clinicians and has made its recommendations. (It also acts as an arm for doctors to avoid malpractice lawsuits, but that is a different story.)
For the treatment of chorioamnionitis, the ACOG’s recommendations are that:
- Administration of intrapartum antibiotics is recommended whenever an intraamniotic infection is suspected or confirmed. Antibiotics should be considered in the setting of isolated maternal fever unless a source other than intraamniotic infection is identified and documented.
- Regardless of institutional protocol, when obstetrician-gynecologists or other obstetric care providers diagnose an intraamniotic infection or when other risk factors for early-onset neonatal sepsis are present in labor (e.g., maternal fever, prolonged rupture of the membranes, or preterm birth), communication with the neonatal care team is essential to optimize neonatal evaluation and management.
That ACOG Guideline relates to expectant management following premature rupture of membranes. It does not explicitly address either (1) the criteria for a clinical diagnosis of chorioamnionitis or (2) the intrapartum management of a patient who meets the clinical diagnosis of chorioamnionitis.
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.
- Chorioamnionitis FAQ