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A R Markos FRCOG FRCP Consultant in Genito Urinary Medicine and Sexual Health 

A Medico Legal Claim for  Cervical Chlamydia Infection  &  Pre-term Delivery  Association or Causation. A R Markos FRCOG FRCP Consultant in Genito Urinary Medicine and Sexual Health  Mid Staffordshire NHS Foundation Trust. Case Summary. 17 years old Unplanned Pregnancy / O.C.P .

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A R Markos FRCOG FRCP Consultant in Genito Urinary Medicine and Sexual Health 

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  1. A Medico Legal Claim for Cervical Chlamydia Infection & Pre-term Delivery Association or Causation A R Markos FRCOG FRCP Consultant in Genito Urinary Medicine and Sexual Health  Mid Staffordshire NHS Foundation Trust

  2. Case Summary • 17 years old • Unplanned Pregnancy / O.C.P. • Smoking: 5-15 cigarettes / day • Alcohol: Occasional • Shared Care • Emergency Admission • Vaginal Bleeding / RIF Pain

  3. Abd/E Suprapubic Tenderness V/E Inflammation of Cervix / Discharge U/S :15w Swabs :HVS : Gardenerellavaginalis ChlamydialSwab (EIA & DFA + ve) Letter to GP : +veChlamydia Rx Erythromycin Letter to Patient

  4. Follow up Events • ANC – had Rx from GP ??? swab – N • Recurrent admissions : Abd. pain, bleeding “after sex” • U/S 25w • 999 call – Pre-term Labour: Ritodrine • Chorio-amnionitis: Rx Antibiotics • HVS + Gardenerella • Chlamydia Test +ve N.B. 2nd pregnancy Pre-Term: 29w → Ritodrine → 34w

  5. Trial of the allegation of • breach of duty • Whether any such breach of duty was causativeof the premature delivery

  6. Breach of Duty Failed to: • Inform patient of (a) Chlamydia is STI (b) not free from infection until repeat test “Test of Cure” • Prescribe adequate treatment(Erythromycin 250 QDS, 7d) • Contact tracing and treatment of partner • Refer patient to GUM Clinic • Treat “Bacterial Vaginosis”

  7. Breach of Duty Chlamydia & STI : letters to GPs # confidentiality Referral to GUM: O&G referrals to GUM in early 1990s “Test of Cure”: who’s responsibility -Hospital or GP Validity of Test of cure Efficacy of Rx : BNF advice on dosage 1990s Hospital in breach of duty to re-test for Chlamydia

  8. Breach of Duty Gardenerellavaginalis # Bacterial Vaginosis BV # Prematurity Body of knowledge in 1990s Hospital not in breach of duty to treat Gardenerella

  9. Causation • Chlamydia trachomatis & Prematurity • Gardenerellavaginalis & Prematurity Proof • Balance of probabilities • The negligence was the cause of the adverse consequences • Breach of duty caused or materially contributed to the premature birth

  10. Level of Evidence Chochrane Review : Meta analysis RCOG Antenatal Care Guidelines (2003): Chlamydia t. associated with higher rates of preterm birth Treatment did not alter the incidence of birth before 37 w Bcterial V. is associated with preterm birth (X1.85) Early pregnancy BV >>> preterm birth Meta analysis (4249 pateints) Treatment: No significant differences in rates of preterm birth or perinatal death reduction in PROM   Screening for BV and CT

  11. Setting standards to improve women’s health Royal College ofObstetricians andGynaecologists Risk Management and Medico-Legal Issues In Women’s Health Joint RCOG/ENTER Meeting Please turn off all mobile phones and pagers

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