Abstract
Facts
This was Mrs P's second pregnancy. In 2000, the first pregnancy had resulted in the delivery of her baby by a classical vertical incision on the posterior aspect of the uterus. In addition, Mrs P had a patent ventricular septal defect and she also developed gestational diabetes.
During her second pregnancy, Mrs P also developed gestational diabetes and commenced insulin therapy at 21 weeks gestation. Despite this, the baby's growth was excessive with the abdominal circumference increasingly beyond the 95th centile.
The plan was to delivery the baby by elective Caesarean section at around 37 weeks gestation.
On 8 May 2005, at 34 weeks, Mrs P was admitted to the Defending Trust at 04:10 in constant pain.
While waiting for the registrar to arrive, the midwife prepared Mrs P ‘to go to theatre’.
The registrar attended at 04:30 and, following examination, excluded labour as a cause of Mrs P's pain and gave a differential diagnosis of uterine rupture or concealed abruption. The CTG taken at this time was normal.
The case was discussed the case with the on-call consultant and the plan appeared to have been to adopt a wait-and-see approach and continue CTG monitoring, administer steroids and commence a sliding scale of insulin and dextrose.
At 05:40, there was difficulty in monitoring the baby and at 05:48, the CTG showed the commencement of terminal branchiacardia.
At 05:50, a decision was made to perform an emergency Caesarean section.
The baby was born at 06:20. He was flat and despite resuscitation, died 6 hours after delivery.
The Claimants' case
It was the Claimants' case that, on admission, having ruled out labour and diabetic ketoacidosis (blood sugar on admission was 8.8 mmol), the only possible causes of severe, constant lower abdominal pain in Mrs P were uterine rupture or possibly concealed abruption. The Claimants' case was that both these diagnoses require an immediate emergency Caesarean section for delivery.
In relation to causation, it was the Claimants' case that, given that by the time the registrar attended at 04:30 on 8 May, the midwife had already prepared Mrs P for theatre and, on the basis that the registrar's assessment was completed by 04:40, and on the balance of probability, an emergency Caesarean section would have resulted in the baby being delivered no later than 05:00. At that stage, the CTG trace was normal. On the balance of probability, therefore, the baby would have been born in good condition and survived.
The Defence
Liability was denied by the NHSLA at protocol stage and then formally in the Defence after the commencement of proceedings. The Defence argued that while the differential diagnoses was of uterine rupture or concealed abruption, it was appropriate to wait and see how matters developed while further investigations were carried out and mother and baby remained in good condition. The Defence also contended that the clinicians were considering a UTI as a possible cause of Mrs P's continuing pain though this was not recorded in the medical records.
In relation to causation, despite the logical inconsistency of arguing that there was no need to proceed to an emergency Caesarean section because mother and baby were in good condition, the Defendants argued that even if they had proceeded to an emergency Caesarean section, the baby would in any event have been compromised.
Shortly prior to the exchange of expert evidence in this matter, the Defendants conceded liability and causation.
Claims had been advanced for the bereavement award under the Fatal Accident Act and funeral expenses together with psychological injury to Mrs P (there was no additional physical injury) and psychological injury to Mr P who was present throughout.
Following an exchange of expert psychiatric evidence, the claim was settled for £45,000. Special damages were minimal.
By way of comment, the Claimants' case did not change from the Protocol letter which was written on 27 June 2006 until the case settled almost three years later on 6 May 2009.
On behalf of the Claimants, it is very disappointing that Mr and Mrs P, having suffered the loss of their son in such tragic circumstances, should then be put through three years of litigation.