M’s mother had an uneventful full term pregnancy and was admitted to hospital in the early stages of labour. Labour proceeded normally until well into the second stage at which point a prolonged episode of fetal bradycardia (slow heart rate) occurred. Although the CTG trace in the early part of labour was at times unusual it was not considered to be pathological.
The doctor was not informed until 7 minutes after the start of the bradycardia and did not arrive until 15 minutes after this. An episiotomy was performed at this stage followed by a normal delivery. M was floppy at birth with no spontaneous respiration and he was not adequately resuscitated until 4 minutes after birth. He went on to develop hypoxic encephalopathy and had multi organ involvement. In other words he had all the typical symptoms of severe intra-partum asphyxia.
All experts instructed were of the opinion that M would have survived without brain damage had he been delivered within 15 minutes of the start of the bradycardia but in fact it was 35 minutes before he was delivered during which time he suffered profound asphyxia. The timing of delivery was the crux of the case. As the baby’s head was well down on the perineum by the time the doctor arrived it would have been possible to undertake an assisted vaginal delivery with forceps.
M has mild to moderate intellectual impairment and severe athetoid Cerebral Palsy involving all 4 limbs. He cannot walk and suffers from marked facial contortions making talking and eating difficult.
There was a great deal of discussion amongst the experts about the accuracy of the CTG tracings. Precise timings were absolutely fundamental to the outcome of the case but were extremely difficult to ascertain. After intense negotiations a settlement of £2.75 million was agreed upon which reflected a discount on the full value of the claim, having taken into account the uncertain prospects of succeeding with the claim at trial given the problems with the interpretation of the CTG trace. The settlement was approved by Mr Justice Hughes sitting in the High Court in Manchester.
B’s mother was admitted to her local maternity hospital as a precautionary measure 12 days before her expected date of delivery (EDD) because the lie of the fetus was unstable and there was a risk of the umbilical cord prolapsing during delivery. She was informed that her EDD was in fact a week later than previously thought and as her consultant was on leave until then she should remain in hospital until his return.
She in fact went into labour on the evening before the original EDD when the fetus was lying obliquely across the uterus rather than head down, as it should ideally have been. On telephone advice from a consultant the junior doctor attending attempted to turn the fetus into a head down position (external version) and then ruptured the membranes so that the head would descend further into the pelvis.
Unfortunately, before this could happen the cord did in fact prolapse and as labour progressed became compressed between the fetal head and the mother’s pelvis resulting in a reduction in the fetal blood (and therefore oxygen) supply. The junior doctor attempted to push the head up to take the pressure off the cord and maintain the fetal circulation but this was only partially successful.
The consultant was again contacted and agreed to attend for a possible Ventouse or Caesarean Section delivery but this took 40 minutes from the time of the initial cord prolapse during which time B suffered profound asphyxia. His Apgar scores were 2, 5 and 6/7 at birth, 40 mins. and 55 mins. respectively. He suffered severe brain damage and developed athetoid cerebral palsy. It was alleged that as there was clearly a risk of cord prolapse on rupture of the membranes, and as B’s mother was close to her due date and might go into spontaneous labour at any time it was negligent not to make a proper management plan for delivery. B’s case was that, on the balance of probabilities, if an experienced obstetrician had attended his mother, an elective CS would have been planned and the cord prolapse and injury to the brain avoided.
B is now in his early 20’s and because of his brain injury has involuntary movements of all 4 limbs and cannot stand or walk nor use his arms effectively in many circumstances. However, he is of above average intelligence and can operate an electric wheelchair, a computer keyboard and an environmental control system.
Interim payments during the case allowed him to purchase suitable accommodation and implement a full care regime to facilitate his attendance at university.
The Defendants initially denied liability but subsequently provided admissions and made a Part 36 offer of £4.25 million that was eventually increased to £5 million.
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