The judgment emphasizes that the medical practitioners' actions did not constitute negligence, as they adhered to accepted standards of care.

[1] On 29 July 2011, the learned High Court Judge dismissed the plaintiffs' claim against the 1st, 2nd and 6th defendants with costs to be taxed and paid by the plaintiffs to the defendants. This is the plaintiffs' appeal against that decision. The claim against the 3rd, 4th and 5th defendants were withdrawn during the hearing at the High Court.

[2] In this appeal, the parties shall be referred to as they were before the High Court.

Background Facts

[3] At all material times, the 1st defendant (Dr Kuppu Velumani P) and the 2nd defendant (Dr Marlik Abu) practised at the Ampang Puteri Specialist Hospital (3rd defendant) as Consultant Obstetrician and Gynaecologist. The 1st plaintiff, Zulhasnimar binti Hassan Basri was a patient of the 1st defendant. The 2nd plaintiff was born premature on 3 May 2002 at the Ampang Puteri Specialist Hospital.

[4] At the early hours of 3 May 2002, the 1st plaintiff arrived at the Ampang Puteri Specialist Hospital with abdominal pain. She was in her 36th week of pregnancy that is, the pre-term of her pregnancy. First CTG was undertaken between 6.11am and 6.29am. Vagina examination ("VE") was done.

[5] At about 9.00am, 1st defendant performed a VE on the 1st plaintiff. The 1st plaintiff's cervix was found thick, only 1cm. The 1st defendant noted the result of the first CTG, and stated that "foetal heart good and no contractions". The 1st defendant ordered a second CTG to be done and queried whether early labour since the 1st plaintiff felt "mild contractions". The second CTG was carried out between 8.50am to 9.10am. The 1st defendant noted the second CTG results and found that the foetal heart was good and contractions were "irregular and mild". At 10.00am, the 1st defendant concluded that the 1st plaintiff was not in labour.

[6] At around 10.55am, the 1st plaintiff collapsed as a result of severe bleeding. Code Blue was called. The 1st plaintiff was resuscitated in the ward and sent to the operation theatre ("OT"). Haemaccel was used in the ward to resuscitate the 1st plaintiff. PW2 (Sariman bin Saad), 1st plaintiff's husband was asked to sign consent papers to a caesarean section ("CS") and a hysterectomy of the 1st plaintiff.

[7] The 1st defendant was assisted by the 2nd defendant in the OT. A lower segment caesarean section ("LSCS") was performed on the 1st plaintiff at around 11.20am. A hysterectomy was conducted and placenta percreta was discovered. At around 11.25am, 2nd plaintiff was delivered. The 2nd plaintiff was born prematurely with severe prenatal asphyxia and with transient multiorgan failure.

[8] The 2nd plaintiff is suffering from severe birth asphyxia leading to hypoxic ischemic encephalopathy ("HIE"). DW2, Dr Lim Chin Thean, an expert witness and neonatologist professor testified that "Birth asphyxia is the most common and important cause of preventable cerebral injury in the neo natal period". The plaintiffs then sued the defendants for medical negligence.

High Court Decision

[9] The issues raised before the High Court were as follows: (i) whether an elective CS should have been planned; (ii) whether the 1st plaintiff was in fact in labour upon admission or anytime; and that the 1st defendant had in fact provided correct assessment in treating the 1st plaintiff; (iii) what is the probable cause of the collapse in the 1st plaintiff, is it due to uterine rupture or rupture of the vessels on the uterus resulting from a condition called placenta percreta?; (iv) whether the cause of collapse is foreseeable by the 1st defendant; (v) whether the 1st plaintiff was resuscita