Obstetrics and Gynaecology Claims

These claims consistently outnumber those in any other medical speciality. Obstetric cases are about double those in gynaecology. The majority are brought on behalf of a baby but a small number arise because of injury (and occasionally death) to the mother.

The commonest type of gynaecological claim is for failed sterilisation and most of the others deal with complications of surgery.

Obstetric claims include -

• Damage to baby because of inadequately managed labour or delivery
• Damage to baby because of failure to recognise a high risk pregnancy
• Incorrectly sutured episiotomy
• Failure to recognise extent of vaginal tear
• Inadequate management of pre-eclampsia
• Failure to diagnose ectopic pregnancy
• Failure to detect abnormalities in foetus
• Anaesthetic Awareness

Gynaecology claims include –

• Failed sterilisation
• Incontinence following surgery
• Perforation of uterus during insertion of contraceptive coil
• Injuries during termination of pregnancy
• Damage during laparoscopic investigations or surgery
• Injury to bladder, bowel or ureters during hysterectomy
• Unnecessary operations
• Defective consent to medical procedures
• Infection resulting in loss of child bearing potential

If you have been harmed as a result of poor judgment you may be able to claim compensation for clinical negligence. Over the years the clinical negligence experts at JMW Medical Negligence Solicitors have successfully recovered damages for many patients and have become experts in this field of medical negligence law.

JMW Solicitors have one of the most experienced and respected medical and clinical negligence compensation claims teams in the UK. We are able to deal with cases using public funding (formerly Legal Aid) or No Win No Fee in appropriate cases.  If after talking to us you decide not to take matters further you are under no obligation to do so and you will not be charged for our initial advice session.

For an assessment of your potential claim, please click here to complete our online enquiry form and one of our specialists will contact you shortly or please contact us on 0845 402 0001.

IN THE HIGH COURT OF JUSTICE CASE NO: MA 291480
QUEENS BENCH DIVISION
MANCHESTER DISTRICT REGISTRY

B E T W E E N:

 VINCENT EDIDIONG EKITOK Claimant
 (A Child by his Mother & Litigation Friend,
 Carole Ekitok)

 -v-

 CENTRAL MANCHESTER & MANCHESTER CHILDRENS
 UNIVERSITY HOSPITALS NHS TRUST Defendant

   CASE REPORT - SETTLEMENT -
 MR. JUSTICE OUSELEY SITTING IN THE HIGH COURT OF JUSTICE,
 QUEEN’S BENCH DIVISION, MANCHESTER DISTRICT REGISTRY
 ON THE 14TH MAY 2007

Background to the claim

In 1994, in early pregnancy, the claimant’s mother was referred to Miss Pamela Buck, Consultant Obstetrician at St. Mary’s Hospital, Manchester.  Mrs. Ekitok had 2 other children; Herbert who was born on the 18th February 1987 at the University College Hospital, London, and Ignatius who was born on the 13th February 1988 at North Manchester General Hospital.

Mrs Ekitok’s pregnancy with Herbert was complicated by proteinuria and high blood pressure at 32 weeks.  She was treated with anti-hypertensive medication and admitted to hospital at 38 weeks.  Herbert was born vaginally at 39 weeks with no subsequent difficulties arising.

The pregnancy with Ignatius was again complicated by the development of hypertension and proteinuria at about 32 weeks and Mrs Ekitok was admitted to hospital for close monitoring.  Her blood pressure came down but she was readmitted with unstable hypertension and remained in hospital until delivery was induced at 38 weeks.

When Mrs Ekitok was 19 weeks pregnant with Vincent it was agreed at an initial appointment in June 1994 that in the light of her previous history, plus a family history of hypertension, that she would receive hospital consultant care only. At that time her blood pressure was 150/90.
 
It was further agreed with Miss Buck that the claimant’s father, who was then practising as an obstetrician, would monitor his wife’s blood pressure at home and if her diastolic pressure exceeded 100, or if she complained of headaches or flashing lights, he would notify the hospital.

Mrs Ekitok’s blood pressure increased as the pregnancy progressed.  When she was 31 weeks pregnant she was admitted for observation after her diastolic blood pressure was measured at 105.  Her blood pressure reduced and she was discharged after 48 hours.
On 29 September 1994 when Mrs Ekitok was 36 weeks pregnant both she and her husband attended the antenatal clinic. Dr. Ekitok took along blood pressure charts demonstrating that his wife’s diastolic blood pressure was now constantly around 100. There was also evidence of proteinuria. 

On the 4 October 1994 Mrs Ekitok was admitted to St. Mary’s Hospital complaining of frontal headaches.  On admission her blood pressure was 190/120.  She had slight oedema of her feet and the urine sample was noted as “+ protein”. The plan was to treat with intravenous Labetolol and to closely monitor her blood pressure. (Labetolol is a potent anti-hypertensive recommended for use in pregnancy)

At 2330 hours Mrs. Ekitok was admitted to the central delivery unit where frequent monitoring of her diastolic blood pressure showed levels of 110/112. Because she had no other symptoms and her urine was free of protein it was decided that intravenous Labetolol was unnecessary and 200mgs was given orally instead.
    
Mrs Ekitok’s blood pressure remained high, but stable, overnight and by 0850 the next morning (5 October 1994) it was down to 170/105 and she was transferred to the ward. However, by 1030 hours it had gone up to 180/120 and a second dose of 200mgs of Labetolol was given orally. An hour later the blood pressure was even higher at 190/125 and at midday she was transferred to the central delivery unit.  Perhaps surprisingly she had no headache or visual disturbance. 

At 1245 hours the registrar attended and noted that the diastolic pressure was steady at about 115 and that she was asymptomatic and her urine was clear of protein.  The CTG showed a baseline heart rate of 140bpm with adequate variability and no decelerations. At 1325 hours she was reviewed by Miss Buck who noted that Mrs Ekitok had responded well to oral Labetolol and that her blood pressure was, at the time of the note, 170/105.  She stated the CTG was normal, and set out a plan of action as follows:-

“For regular Labetolol dose.
If BP settles to Ward SM4
If BP controlled deliver next week.
If BP not controlled deliver”.

At 1400 hours a third dose of oral Labetolol was given and Mrs Ekitok was returned to the ward as the blood pressure appeared to be stabilising. However, by 1825 hours it was up again to 180/115 and a further dose of oral Labetolol was given.

Miss Buck saw Mrs Ekitok at 1915 and decided to continue the present plan of oral Labetolol 4 times a day.  She noted “if BP cannot be controlled by this dose I think delivery would be the better option”.

Mrs Ekitok’s blood pressure remained high but reasonably stable overnight and the next morning (6.10.94) Miss Buck decided to continue conservative management “for now”.

By 1440 the blood pressure had gone up to 190/120 and the CTG trace showed reduced baseline variability and distinct unchallenged decelerations of the fetal heart from a baseline of 140bpm down to 90bpm.  This was an abnormal trace suggestive of incipient fetal compromise.  Towards the end of the trace there was evidence of improved fetal activity.

AT 1630 hours Miss Buck noted that the diastolic pressure had again increased to 120 and that the patient was becoming increasingly upset.  Following a discussion with Mrs Ekitok and her husband Miss Buck wrote “I think she should be delivered…I think a reasonable chance of vaginal delivery. Agreed by couple”.

At 1700 and again at 1830 hours the central delivery unit was contacted but was unable to take Mrs. Ekitok for an induction of labour.

At 2030 hours Mrs Ekitok suffered a massive placental abruption on the ward and was transferred immediately to the central delivery unit. She was bleeding profusely and required resuscitation. Her blood pressure dropped to 143/87 and she lost a total of over 3 litres of blood. The claimant was born by emergency caesarean section at 2055 hours in exceedingly poor condition and suffered significant brain injury.

The Allegations of Negligence

The claimant alleged that the defendant was negligent in the following respect :-

1. By failing to plan for the treatment of Mrs Ekitok’s hypertension once her diastolic blood pressure was constantly higher than 100. Given the family history and her history in previous pregnancies it was alleged that no reasonable obstetrician would delay treatment once a consistent diastolic pressure of greater than 100 was reached.

2. By failing to make any proper assessment of the risks and benefits of alternative treatments before deciding on a care plan when Mrs Ekitok was admitted to hospital on  4 October 1994 with repeated readings of diastolic pressure in excess of 100.
 The claimant alleged that there were only 2 alternative courses of action open to the treating doctors; either delivery or conservative treatment to attempt to stabilise blood pressure by medication.  As the Claimant was 36 weeks + 4 days gestation the risks of delivery then, rather than at 37 weeks or later, were negligible.  On the other hand the risks of delay were considerable.  There was a real risk of placental abruption and of the mother suffering a cerebral haemorrhage.

 3. Having decided to treat Mrs. Ekitok conservatively the defendant failed to prescribe and give appropriate anti-hypertensive medication. The claimant alleged that oral Labetolol was inadequate and should have been given intravenously as originally intended.

4. By Midday on 5 October 1994 the defendant failed to deliver Mrs Ekitok without delay despite an exceptionally high blood pressure, deciding instead to continue with a conservative approach despite the fact that there had been a poor response to Labetolol. Also the Defendant did not use effective ongoing anti-hypertensive drug therapy.

5. It was further alleged that the defendant failed to note the abnormal features on the CTG trace between 1030 and 1115 hours on 6 October 1994 and plan for immediate delivery.  Also there was a failure at 1630 hours on 6 October, in the light of the information then available, to plan for emergency caesarean section.

Causation

The claimant alleged that had appropriate steps been taken to deliver him and had delivery been effected prior to the placental abruption at 2030 hours on 6 October 1994 he would have been born healthy and would have been spared his brain injury.

The Defence

Liability was denied. 

The defendant claimed that the regime for the monitoring and treatment of Mrs Ekitok’s blood pressure was at all times appropriate.  With regard to causation, the defendant contended that inducing Mrs Ekitok would, in all likelihood, have resulted in a placental abruption.

A joint settlement meeting attended by legal representatives by both parties took place on 15 November 2004 when liability issues were discussed.  Following detailed negotiations it was agreed that the defendant would consent to judgment being entered for 75% of damages.

This compromise was approved by the Court on 10 December 2004.

Quantification

The quantification of the claim was delayed due to deterioration in the claimant’s presentation, which required a detailed review of the appropriateness or otherwise of surgical intervention before a proper assessment of the claimant’s future needs could be made.  Ultimately it was decided that further surgery would not be appropriate and thereafter quantification of the claim took place.

The Settlement

The matter came before the Court on 14 May 2007 for approval of the settlement in the following terms:-

The capitalised value of the claimant’s damages was agreed at £4,285,850 (75% of the full value of the claim).  This was to be paid as a capital sum of £1,391,850 together with periodical payments of £107,500 to the age of 19 and £122,750 thereafter. 

On the subject of indexation the Court approved the position agreed by the parties that the indexation of care and case management in the future should follow the decision of the Court of Appeal and/or the House of Lords in the case of Thompstone. 

In addition the claimant agreed to a reverse indemnity. This required the litigation friend’s co-operation with any assessments made by the relevant statutory bodies and to pay to the defendant 75% of any monetary payments received by those statutory bodies.

Solicitor for the Claimant
Eddie Jones
JMW Solicitors

Counsel for the Claimant
Andrew Moran QC
7 Harrington Street Chambers
Liverpool

Michael Smith
8 King Street
Manchester

Solicitor for the Defendant
Hempsons
Manchester

Counsel for the Defendant
Philip Havers QC -and-
Mr. Gregory Chambers