Clinical practice

Area of Science:

• Neurology
• Perinatal Medicine
• Medical Litigation

Background:

• Basal ganglia and thalamus (BGT) hypoxic-ischaemic brain injury is a significant issue in South African cerebral palsy (CP) litigation.
• This pattern of injury is frequently linked to a perinatal sentinel event (PSE), which is typically sudden, unforeseen, and unpreventable.
• Antepartum conditions can prime the fetus, increasing vulnerability to BGT injury from even minor hypoxic insults.

Purpose of the Study:

• To provide a consensus response to BGT hypoxic-ischaemic brain injury in CP litigation.
• To analyze the association between BGT injury and perinatal sentinel events (PSEs).
• To discuss the clinical implications for prevention and case review.

Main Methods:

• Review of international literature on BGT hypoxic-ischaemic brain injury.
• Analysis of the typical onset and preventability of perinatal sentinel events (PSEs).
• Examination of factors contributing to fetal vulnerability and injury patterns.

Main Results:

• BGT pattern injury is strongly associated with sudden-onset, unforeseen perinatal sentinel events (PSEs).
• Fetal priming from antepartum pathologies can increase susceptibility to BGT injury.
• While often sudden, BGT injury can uncommonly follow gradual fetal heart rate deterioration over ≥1 hour.

Conclusions:

• Preventing BGT injury requires a delivery interval of 10-20 minutes from PSE onset, which is challenging in South Africa.
• Each case necessitates a comprehensive, multidisciplinary review of all available clinical information for fair resolution.
• International literature supports a consensus approach to managing BGT hypoxic-ischaemic brain injury in CP litigation.