A R Markos FRCOG FRCP A R Markos FRCOG FRCP Consultant in Genito Urinary Medicine and Sexual Consultant in Genito Urinary Medicine and Sexual Health Health Mid Staffordshire NHS Foundation Trust Mid Staffordshire NHS Foundation Trust
A R Markos FRCOG FRCP Consultant in Genito Urinary Medicine and Sexual Health
Jan 01, 2016
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 . - PowerPoint PPT Presentation
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A R Markos FRCOG FRCPA R Markos FRCOG FRCP Consultant in Genito Urinary Medicine and Sexual Consultant in Genito Urinary Medicine and Sexual
Health Health Mid Staffordshire NHS Foundation TrustMid Staffordshire NHS Foundation Trust
Mid StaffordshireNHS Foundation Trust
NHS
17 years old17 years old Unplanned Pregnancy / O.C.P.Unplanned Pregnancy / O.C.P. Smoking: 5-15 cigarettes / daySmoking: 5-15 cigarettes / day Alcohol: OccasionalAlcohol: Occasional Shared CareShared Care Emergency AdmissionEmergency Admission Vaginal Bleeding / RIF PainVaginal Bleeding / RIF Pain
Mid StaffordshireNHS Foundation Trust
NHS
Abd/EAbd/ESuprapubic TendernessSuprapubic TendernessV/EV/E Inflammation of Cervix / Inflammation of Cervix /
DischargeDischargeU/SU/S :: 15w15wSwabs :Swabs : HVS : Gardenerella vaginalisHVS : Gardenerella vaginalis
Chlamydial Swab (EIA & DFA Chlamydial Swab (EIA & DFA + ve)+ ve)
Letter to GP : +ve ChlamydiaLetter to GP : +ve Chlamydia
Rx ErythromycinRx ErythromycinLetter to PatientLetter to Patient
Mid StaffordshireNHS Foundation Trust
NHS
ANC – had Rx from GP ??? swab – NANC – had Rx from GP ??? swab – N Recurrent admissions : Abd. pain, bleeding Recurrent admissions : Abd. pain, bleeding
“after sex”“after sex” U/S 25wU/S 25w 999 call – Pre-term Labour: Ritodrine999 call – Pre-term Labour: Ritodrine Chorio-amnionitis: Rx AntibioticsChorio-amnionitis: Rx Antibiotics HVS + GardenerellaHVS + Gardenerella Chlamydia Test +veChlamydia Test +ve N.B.N.B. 2 2ndnd pregnancy Pre-Term: 29w → Ritodrine → pregnancy Pre-Term: 29w → Ritodrine →
34w34w
Mid StaffordshireNHS Foundation Trust
NHS
breach of dutybreach of duty
Whether any such breach of duty was Whether any such breach of duty was causativecausative of the premature delivery of the premature delivery
Mid StaffordshireNHS Foundation Trust
NHS
Failed to:Failed to:1.1.Inform patient ofInform patient of
(a) Chlamydia is STI(a) Chlamydia is STI(b) not free from infection until repeat test “Test (b) not free from infection until repeat test “Test
of Cure”of Cure”
2.2.Prescribe adequate treatmentPrescribe adequate treatment(Erythromycin 250 (Erythromycin 250
QDS, 7d)QDS, 7d)3.3. Contact tracing and treatment of partnerContact tracing and treatment of partner4.4. Refer patient to GUM ClinicRefer patient to GUM Clinic5.5. Treat “Bacterial Vaginosis”Treat “Bacterial Vaginosis”
Mid StaffordshireNHS Foundation Trust
NHS
Chlamydia & STI : letters to GPs # confidentialityChlamydia & STI : letters to GPs # confidentiality
Referral to GUM: Referral to GUM: O&G referrals to GUM in early 1990s O&G referrals to GUM in early 1990s
““Test of Cure”:Test of Cure”: who’s responsibility -Hospital or GPwho’s responsibility -Hospital or GP
Validity of Test of cureValidity of Test of cure
Efficacy of Rx : Efficacy of Rx : BNF advice on dosage 1990sBNF advice on dosage 1990s
Hospital in breach of duty to re-test for ChlamydiaHospital in breach of duty to re-test for Chlamydia
Mid StaffordshireNHS Foundation Trust
NHS
Gardenerella vaginalis # Bacterial VaginosisGardenerella vaginalis # Bacterial Vaginosis
BV # PrematurityBV # Prematurity
Body of knowledge in 1990sBody of knowledge in 1990s
Hospital not in breach of duty to treat Hospital not in breach of duty to treat
GardenerellaGardenerella
Mid StaffordshireNHS Foundation Trust
NHS
CausationCausation Chlamydia trachomatis & PrematurityChlamydia trachomatis & Prematurity Gardenerella vaginalis & PrematurityGardenerella vaginalis & Prematurity
ProofProof Balance of probabilitiesBalance of probabilities The negligence was the The negligence was the causecause of the of the
adverse consequencesadverse consequences Breach of duty Breach of duty caused or materially caused or materially
contributedcontributed to the premature birth to the premature birth
Mid StaffordshireNHS Foundation Trust
NHS
Chochrane Review : Meta analysisChochrane Review : Meta analysis
RCOG Antenatal Care Guidelines (2003):RCOG Antenatal Care Guidelines (2003):
Chlamydia t. Chlamydia t. associated with higher rates of preterm birthassociated with higher rates of preterm birth
Treatment did not alter the incidence of birth Treatment did not alter the incidence of birth before 37 wbefore 37 w
Bcterial V. Bcterial V. is associated with preterm birth (X1.85) is associated with preterm birth (X1.85)
Early pregnancy BV >>> preterm birthEarly pregnancy BV >>> preterm birth
Meta analysis (4249 pateints)Meta analysis (4249 pateints)
Treatment: No significant differences in Treatment: No significant differences in rates of preterm birth or rates of preterm birth or perinatal death perinatal death
reduction in PROMreduction in PROM
Screening for BV and CTScreening for BV and CT
Royal College ofObstetricians andGynaecologists
Setting standards to improve women’s health
Risk Management and Medico-Legal Issues In Women’s HealthJoint RCOG/ENTER Meeting
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