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Cerebral palsy and its medicolegal implications in low-resource settings – the need to establish causality and revise criteria to implicate intrapartum hypoxia : a narrative review

dc.contributor.authorBhorat, I.
dc.contributor.authorBuchmann, E.
dc.contributor.authorSoma-Pillay, Priya
dc.contributor.authorNicolaou, E.
dc.contributor.authorPistorius, L.
dc.contributor.authorSmuts, Izelle
dc.contributor.authorVelaphi, S.
dc.date.accessioned2024-01-29T08:56:25Z
dc.date.available2024-01-29T08:56:25Z
dc.date.issued2023-07
dc.description.abstractThe 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.en_US
dc.description.departmentObstetrics and Gynaecologyen_US
dc.description.departmentPaediatrics and Child Healthen_US
dc.description.librarianam2024en_US
dc.description.sdgSDG-03:Good heatlh and well-beingen_US
dc.description.urihttps://samajournals.co.za/index.php/samj/indexen_US
dc.identifier.citationBhorat, I. Buchnan, E., Soma-Pillay, P et al. 2023, 'Cerebral palsy and its medicolegal implications in lowresource settings – the need to establish causality and revise criteria to implicate intrapartum hypoxia', South African Medical Journal, vol. 113, no. 7, pp. 1263-1267. https://DOI.org/10.7196/SAMJ.2023.v113i6.229.en_US
dc.identifier.issn0256-9574 (print)
dc.identifier.issn2078-5135 (online)
dc.identifier.other10.7196/SAMJ.2023.v113i6.229
dc.identifier.urihttp://hdl.handle.net/2263/94132
dc.language.isoenen_US
dc.publisherSouth African Medical Associationen_US
dc.rights© Creative Commons Attribution - NonCommercial Works License (CC BY-NC 4.0).en_US
dc.subjectCerebral palsy (CP)en_US
dc.subjectObstetric caregiversen_US
dc.subjectNeonatal encephalopathyen_US
dc.subjectBrainen_US
dc.subjectSDG-03: Good health and well-beingen_US
dc.titleCerebral palsy and its medicolegal implications in low-resource settings – the need to establish causality and revise criteria to implicate intrapartum hypoxia : a narrative reviewen_US
dc.typeArticleen_US

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