Chorioamnionitis and Maternal Infection Malpractice in New York

What Is Chorioamnionitis?

Risk Factors

Chorioamnionitis is an infection of the placenta and fetal membranes. It occurs when bacteria (typically from the vagina or rectum) ascend through the cervix and into the uterus after the membranes have ruptured. The infection can involve the placenta, the umbilical cord, and the baby.

Chorioamnionitis is also known as intra-amniotic infection (IAI) or amnionitis. It occurs in approximately 1-4% of all deliveries, but the rate is higher in women with prolonged labor or prolonged rupture of membranes.

• Prolonged rupture of membranes: The longer the membranes are ruptured before delivery, the higher the risk of infection. Rupture of membranes for more than 18-24 hours significantly increases the risk.
• Prolonged labor: Long labor increases the time bacteria have to ascend into the uterus.
• Multiple vaginal exams during labor: Each vaginal exam introduces bacteria into the cervix and uterus.
• Internal fetal monitoring: Internal fetal monitoring (scalp electrode or intrauterine pressure catheter) introduces bacteria into the uterus. [Link to: /medical-malpractice/fetal-monitoring-errors]
• Group B Streptococcus (GBS) colonization: Women colonized with GBS are at higher risk of chorioamnionitis.
• Maternal infection: Existing urinary tract infection or other maternal infection increases risk.
• Premature labor: Preterm labor and delivery carry a higher risk of chorioamnionitis.
• Meconium-stained amniotic fluid: Presence of meconium may be associated with infection. [Link to: /birth-injury/meconium-aspiration-lawyer]

Signs and Symptoms of Chorioamnionitis

The standard of care requires that obstetricians recognize the signs of chorioamnionitis and begin treatment promptly. The classic signs include:

• Maternal fever: A temperature of 100.4°F (38°C) or higher during labor is the most common sign. Any maternal fever during labor should raise concern for chorioamnionitis.
• Maternal tachycardia: Rapid heart rate (above 100 bpm) in the mother.
• Fetal tachycardia: Rapid heart rate (above 160 bpm) in the baby, seen on the fetal monitor. This is an important sign of fetal distress due to infection. [Link to: /medical-malpractice/fetal-monitoring-errors] [Link to: /labor-delivery-errors/failure-to-recognize-fetal-distress]
• Uterine tenderness: Pain or tenderness when the abdomen is touched, indicating inflammation of the uterus.
• Foul-smelling amniotic fluid: Purulent or foul-smelling amniotic fluid is a sign of infection.
• Maternal leukocytosis: Elevated white blood cell count on blood test.

The Standard of Care for Managing Chorioamnionitis

When chorioamnionitis is suspected or diagnosed, the standard of care requires:

• Initiate antibiotics promptly: Antibiotics should be started as soon as chorioamnionitis is suspected. The standard regimen includes ampicillin and gentamicin (given intravenously). Delay in antibiotic treatment is a common and dangerous error. Antibiotics should be continued through delivery and for a period after.
• Initiate sepsis workup for the newborn: After delivery, the baby should be evaluated for neonatal sepsis, including blood tests and possibly a lumbar puncture (spinal tap) and chest X-ray. [Link to: /medical-malpractice/sepsis-malpractice] [Link to: /misdiagnosis/meningitis-misdiagnosis]
• Administer antibiotics to the newborn: If the baby shows signs of infection, antibiotics should be started promptly.
• Consider expedited delivery: Once chorioamnionitis is diagnosed, the baby should be delivered. The mode of delivery (vaginal or C-section) depends on the obstetric situation, but prolonged labor in the setting of chorioamnionitis is not appropriate. If labor is not progressing, a C-section may be required. [Link to: /medical-malpractice/delayed-c-section]
• Monitor for maternal and fetal complications: Continuous monitoring of maternal vital signs and fetal heart rate to detect deterioration. [Link to: /medical-malpractice/fetal-monitoring-errors]
• Group B Strep prophylaxis: All women should be screened for GBS during pregnancy, and those who are positive should receive intrapartum antibiotics to prevent neonatal GBS infection.
• Limit vaginal exams: Minimize the number of vaginal exams during labor to reduce the risk of introducing bacteria.
• Avoid internal monitoring when possible: Use external fetal monitoring when possible to reduce the risk of infection. [Link to: /medical-malpractice/fetal-monitoring-errors]

Consequences of Chorioamnionitis

Maternal Consequences

Chorioamnionitis can have devastating consequences for both mother and baby:

• Maternal sepsis: The infection can spread to the bloodstream, causing sepsis -- a life-threatening condition characterized by low blood pressure, organ failure, and potentially death. [Link to: /medical-malpractice/sepsis-malpractice]
• Postpartum hemorrhage: Infection can impair uterine contraction after delivery, increasing the risk of postpartum hemorrhage. [Link to: /labor-delivery-errors/postpartum-hemorrhage]
• Wound infection: Infection can spread to C-section incisions or episiotomy sites.
• Endometritis: Infection of the uterine lining after delivery.
• Maternal death: In severe cases, chorioamnionitis can be fatal. [Link to: /wrongful-death-lawyer]

Neonatal Consequences

Neonatal sepsis: The baby can develop sepsis -- a life-threatening bloodstream infection. Neonatal sepsis requires prompt antibiotic treatment and can cause brain damage, organ failure, and death. [Link to: /medical-malpractice/sepsis-malpractice]

• Neonatal meningitis: Infection can spread to the baby's brain and the membranes surrounding it (meninges), causing meningitis. Meningitis can cause brain damage, seizures, developmental delays, and death. [Link to: /misdiagnosis/meningitis-misdiagnosis]
• Cerebral palsy: Chorioamnionitis is a known risk factor for cerebral palsy. The inflammatory response to infection can damage the developing brain, causing white matter injury (periventricular leukomalacia, or PVL) that leads to cerebral palsy. [Link to: /cerebral-palsy-lawyer/new-york] [Link to: /birth-injury/pvl-lawyer]
• Hypoxic-ischemic encephalopathy (HIE): Infection can increase the baby's vulnerability to oxygen deprivation, worsening brain injury. [Link to: /medical-malpractice/hie-claims]
• Premature birth: Chorioamnionitis is a major cause of preterm labor, which carries its own risks of brain injury and developmental problems.
• Neonatal death: Severe infection can be fatal. [Link to: /wrongful-death/child]

When Chorioamnionitis Management Constitutes Medical Malpractice

Chorioamnionitis malpractice can occur in several ways:

• Failure to recognize chorioamnionitis: The medical team fails to recognize the signs of infection (maternal fever, fetal tachycardia, uterine tenderness, foul-smelling fluid). Maternal fever during labor is a critical sign that should prompt evaluation for chorioamnionitis.
• Delay in antibiotic treatment: The medical team delays starting antibiotics. The standard of care requires that antibiotics be started as soon as chorioamnionitis is suspected -- not after confirming the diagnosis with lab results (which take hours to days).
• Failure to monitor fetal heart rate: The medical team fails to monitor the fetal heart rate continuously, missing signs of fetal distress due to infection. [Link to: /medical-malpractice/fetal-monitoring-errors] [Link to: /labor-delivery-errors/failure-to-recognize-fetal-distress]
• Failure to deliver the baby: Once chorioamnionitis is diagnosed, the baby should be delivered. Prolonged labor in the setting of chorioamnionitis is not appropriate. If labor is not progressing, a C-section may be required. [Link to: /medical-malpractice/delayed-c-section]
• Failure to screen for Group B Strep: The obstetrician fails to screen for GBS during pregnancy or fails to administer intrapartum antibiotics to GBS-positive women.
• Failure to perform neonatal sepsis workup: After delivery of a baby whose mother had chorioamnionitis, the neonatal team fails to perform a sepsis workup or fails to start prophylactic antibiotics.
• Inadequate maternal monitoring: The medical team fails to monitor the mother for signs of sepsis (worsening fever, rapid heart rate, low blood pressure, altered mental status). [Link to: /medical-malpractice/sepsis-malpractice]
• Excessive vaginal exams: The medical team performs excessive vaginal exams during labor, increasing the risk of introducing bacteria.
• Failure to obtain informed consent: The medical team fails to inform the patient of the risks of prolonged rupture of membranes and prolonged labor, and the available options (including induction or C-section).

Proving Your Chorioamnionitis Malpractice Case

To prove a chorioamnionitis malpractice case, we:

• Obtain medical records: Including prenatal records, labor and delivery records, fetal monitoring strips, maternal vital signs, lab results (CBC, blood cultures), antibiotic administration records, neonatal records, and placental pathology. [Link to: /resources/how-to-get-medical-records-for-a-lawsuit]
• Obtain the fetal monitoring strips: The strips show the fetal heart rate pattern, including fetal tachycardia (a sign of infection). [Link to: /medical-malpractice/fetal-monitoring-errors]
• Obtain placental pathology: The placenta should be sent for pathology examination after delivery in cases of suspected chorioamnionitis. The pathology report can confirm the presence and severity of infection.
• Obtain maternal vital signs records: These records show the maternal temperature, heart rate, and blood pressure throughout labor.
• Obtain antibiotic administration records: These records show when antibiotics were ordered and administered.
• Engage expert review: We work with board-certified obstetricians, maternal-fetal medicine specialists, and neonatologists who practice in New York.
• Establish the standard of care: We determine what the standard of care requires for chorioamnionitis diagnosis and management.
• Establish causation: We prove that the delay or failure in management caused the harm (e.g., sepsis, cerebral palsy, or death).
• Establish damages: We quantify the injuries, including life care plan costs for cerebral palsy or other lifelong conditions. [Link to: /brain-injury/life-care-plan]

New York Statute of Limitations

Chorioamnionitis malpractice claims are subject to the 2.5-year statute of limitations for medical malpractice (CPLR 214-a). Key considerations:

• Infancy toll: Under CPLR 208, the statute is tolled while the child is under 18, with a 10-year outer limit for medical malpractice. [Link to: /birth-injury/statute-of-limitations] [Link to: /cerebral-palsy-lawyer/statute-of-limitations]
• Continuous treatment doctrine: If the mother or baby continued to receive treatment from the same provider for the same condition (e.g., treatment for sepsis complications), the statute may be extended.
• Municipal hospitals: If the injury occurred at a municipal hospital (Bellevue, Metropolitan, Harlem, Elmhurst, Queens Hospital Center), a notice of claim must be filed within 90 days. [Link to: /hospital-negligence/suing-nyc-h-h] [Link to: /hospital-negligence/notice-of-claim-guide]
• Wrongful death: If the chorioamnionitis caused death (maternal or neonatal), the wrongful death claim must be filed within 2 years. [Link to: /wrongful-death/child] [Link to: /wrongful-death/statute-of-limitations]

Compensation Available

A successful chorioamnionitis malpractice claim can provide compensation for:

• Medical expenses: Including past and future NICU care, surgeries, medications, therapy, and medical equipment
• Future medical care and life care plan: For lifelong disabilities such as cerebral palsy [Link to: /brain-injury/life-care-plan] [Link to: /cerebral-palsy-lawyer/life-care-plan]
• Lost earnings and lost earning capacity: For the child's reduced ability to work
• Pain and suffering: NY has no cap on non-economic damages
• Special education and developmental services: For cognitive impairments [Link to: /cerebral-palsy-lawyer/special-education]
• New York Medical Indemnity Fund (MIF): For qualifying birth-related neurological injuries [Link to: /birth-injury/medical-indemnity-fund]
• Wrongful death damages: If the chorioamnionitis caused death [Link to: /wrongful-death/child]

Frequently Asked Questions

The value of a medical malpractice case in New York depends on several factors, including the severity of the injury, the strength of liability evidence, and the economic and non-economic damages involved. New York is one of the few states with no caps on medical malpractice damages, meaning there is no artificial limit on what you can recover. Below are typical settlement ranges based on injury severity.