Early online

I Bhorat; E Buchmann; P S Soma-Pillay; E Nicolaou; L Pistorius; I Smuts; S Velaphi

doi:10.7196/SAMJ.2023.v113i6.229

South African Medical Journal (Jun 2023)

Early online

I Bhorat,
E Buchmann,
P S Soma-Pillay,
E Nicolaou,
L Pistorius,
I Smuts,
S Velaphi

Affiliations

I Bhorat: Subdepartment of Fetal Medicine, Department of Obstetrics and Gynaecology, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; Council Member and Chair of Expert Opinion Panel, South African Society of Obstetrics and Gynaecology
E Buchmann: Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
P S Soma-Pillay: Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Pretoria, South Africa; Hon. Secretary, South African Society of Obstetrics and Gynaecology
E Nicolaou: Division of Fetal Medicine, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
L Pistorius: Division of Fetal Medicine, Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
I Smuts: Department of Paediatric Neurology, Faculty of Health Sciences, University of Pretoria, South Africa
S Velaphi: Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

DOI: https://doi.org/10.7196/SAMJ.2023.v113i6.229
Journal volume & issue: Vol. 113, no. 6

Abstract

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The objective of this study was to establish scientific causality and to devise criteria to implicate intrapartum hypoxia in cerebral palsy (CP) in low-resource settings, where there is potential for an increase in damaging medicolegal claims against obstetric caregivers, as is currently the situation in South Africa. For the purposes of this narrative review, an extensive literature search was performed, including any research articles, randomised controlled trials, observational studies, case reports or expert or consensus statements pertaining to CP in low-resource settings, medicolegal implications, causality, and criteria implicating intrapartum hypoxia. In terms of causation, there are differences between high-income countries (HICs) and low-resource settings. While intrapartum hypoxia accounts for 10 - 14% of CP in HICs, the figure is higher in low-resource settings (20 - 46%), indicating a need for improved intrapartum care. Criteria implicating intrapartum hypoxia presented for HICs may not apply to low-resource settings, as cord blood pH testing, neonatal brain magnetic resonance imaging (MRI) and placental histology are frequently not available, compounded by incomplete clinical notes and missing cardiotocography tracings. Revised criteria in an algorithm for low-resource settings to implicate intrapartum hypoxia in neonatal encephalopathy (NE)/ CP are presented. The algorithm relies first on specialist neurological assessment of the child, determination of the occurrence of neonatal encephalopathy (by documented or verbal accounts) and findings on childhood MRI, and second on evidence of antepartum and intrapartum contributors to the apparent hypoxia-related CP. The review explores differences between low-resource settings and HICs in trying to establish causation in NE/CP and presents a revised scientific approach to causality in the context of low-resource settings for reaching appropriate legal judgments.

Published in South African Medical Journal

ISSN: 0256-9574 (Print); 2078-5135 (Online)
Publisher: South African Medical Association
Country of publisher: South Africa
LCC subjects: Medicine: Medicine (General)
Website: https://samajournals.co.za/index.php/samj/index

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Abstract

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