Birth Injuries
Evaluation of a "Birth Injury" Case, Part II (continued)

Legitimate defenses exist within the mechanism of injury defense. For example, a completed embolic stroke occurring in utero is a rare but unheralded event and the injuries caused by it are not preventable. True congenital brain disorders such as trisomy 21 are sometimes preventable by prenatal and/or genetic counseling and testing but are not a result of the labor process. However, it is popular today for a defense expert to claim that intrauterine infection "chorioamnionitis" causes injuries in utero by a mechanism that cannot be identified by health care providers prior to injury occurring and that such injuries cannot be prevented. This, in my view, is an illegitimate claim.

The scientific evidence for brain injuries resulting from an infection in the amnion is limited. [Neurologic sequelae of streptococcal infection are beyond the scope of this paper.] It is important to be aware, however, that authors such as Grether and Nelson, have claimed in the literature that chorioamnionitis is a risk factor for neonatal outcomes commonly attributed to birth asphyxia.(1)

Fortunately, in August of 1999, a massive retrospective cohort study published out of the University of Texas, Southwestern Medical Center, Dallas, Texas, provides strong evidence to the contrary. A total of 101,170 term infants were analyzed. Fully 5% of the infants were born to women with chorioamnionitis (5,144). After adjustment for confounding factors, it was clear that neurologic morbidity was not related to maternal infection during labor but rather was significantly related to other labor complications.(2)

Defense experts hypothesize a variety of esoteric mechanisms to support their claim chorioamnionitis produces irreversible untreatable injuries in utero. Adverse consequences result, they claim, from cytokines, a chemical attractant elaborated by inflammatory cells to recruit other inflammatory cells to the site of infection. The proponents of the brain injuring effects of cytokinesia claim that the cytokines produce brain injury by direct effect on brain tissue and/or by vasoconstriction of blood vessels.

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