FOCIS
FOCIS

Louise's Case


L's pregnancy in 2004 was her second pregnancy and her estimated date of delivery was 18 February 2005. Initially her care was at U C Hospital but she was transferred to S H Hospital due to the fact that she moved house. She had an uncomplicated antenatal period. On 23 February 2005 at 18.55 hours spontaneous rupture of membranes took place and an antenatal examination was performed by a midwife at S H Hospital but despite this, L was discharged home with a date for augmentation.

On 24 February 2005 at 6.10 hours L was self-referred to Hospital in spontaneous labour. At 13.45 hours Syntocinon commenced via intravenous infusion as cervical dilation was slow and the head of the baby was in a posterior position.

At 16.00 hours the cervix was fully dilated, the head was rotated to an occipito-transverse position and was below the ischial spines. At 17.00 hours the senior registrar was called to review the CTG tracings and it was noted that there was fetal tachycardia and late decelerations. At 17.20 hours the midwife advised L to commence pushing. A doctor arrived to review L and a decision was made to perform an instrumental delivery. At 17.35 hours a Ventouse cap was applied and this came off at 17.40 hours. At 17.45 hours the Ventouse was reapplied and at 17.55 hours the Ventouse came off and Wrigley's forceps were then applied. At 18.04 hours H was delivered in a pale floppy condition. The paediatric SHO had not arrived at the time of the delivery and the senior registrar and the Neonatal Unit staff were requested over the intercom. In the meantime resuscitation was initiated by a midwife. At 18.09 hours the Neonatal Unit and the paediatric staff arrived and the care was handed over. At 18.28 hours H was transferred to the Neonatal Unit and intubated.

On 27 February 2005 H died while on the Neonatal Unit. His birth weight was 4.25 kgs and APGAR scores after delivery were 2 at 1 minute and 3 at 5 minutes.
An Incident Report completed by S H Hospital highlighted that L was not seen by the specialist registrar until 17.20 hours despite being prescribed Syntocinon at 13.45 hours. The report also recommended that a ward round should have been done at 13.00 hours and that the midwife could have reassessed the cervical dilation before starting Syntocinon. There was a failure to recognise hyperstimulation of the uterus in the first and second stage of labour

The report also revealed that the Syntocinon should have been maintained at a level that ensured the uterus was contracting efficiently and effectively, i.e. a maximum of 4 contractions in 10 minutes, this would have allowed a sufficient resting phase between contractions. It also says that the midwife acknowledged that the CTG was abnormal and the specialist registrar was called at 17.10 hours. While waiting for the specialist registrar to arrive the midwife started the patient pushing which coincided with the arrival of the specialist registrar. At this stage, we allege that the there was inappropriate use of the Syntocinon infusion when contraction frequency was already optimal. The infusion should have been discontinued when there was acute fetal compromise ie after 17.20 hours.

The report commented on the specialist registrar's decision to use the Ventouse as the preferred instrument of delivery, concluded that the specialist registrar was more confident using the Ventouse rather than mid cavity forceps. Following a discussion with this doctor it was agreed that they would benefit from some supervised practice in order to build their confidence in the use of mid cavity forceps.

In summary, there was inappropriate use of syntocinon when contraction frequency was already optimal. There was a slow response in the face of severe fetal compromise; a failure to recognise hyperstimulation of the uterus; a failure to discontinue the Syntocinon when there was acute fetal compromise and a failure to have paediatric support at delivery.

The above negligent care put L's baby's life at unnecessary risk and failed to identify the profound foetal compromise which led to the death of H.

At the time of the delivery of her son, H, L was 32 years of age and had intended in the future to increase her family. In April 2006 she gave birth to a healthy baby boy by planned caesarean section. The caesarean section was a major abdominal surgical procedure which caused a delay in L's recovery, pain and scarring. She has also suffered psychological problems as a result of H's death.

Results of the Case
A Letter of Claim was served on the Defendants on 14 July 2006 with a Letter of Response received thereafter with a Part 36 offer of £15,000. The Claimant put forward a counter offer on 8 March 2007 of £40,000 and the case settled in October 2007 for £22,500 without medical reports on condition and prognosis.

Please note that all names have been changed to maintain anonymity.

 

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