We have recently settled a claim against Kingston Hospital NHS Foundation Trust relating to the management of the claimant’s pregnancy and the stillbirth of her daughter.
The claimant had a significant obstetric history and following four consecutive miscarriages in 2013 and 2014, she was referred to a haematologist at Kingston Hospital. Following testing she was advised that she was a carrier for a Factor V Leiden mutation, which is a genetic mutation that makes the blood more prone to abnormal clotting. This led to careful haematology reviews during subsequent pregnancies.
In August 2017, the claimant fell pregnant again and in view of her obstetric history she was booked for shared care, with a plan to deliver in the consultant unit at Kingston Hospital.
Notwithstanding her history, the claimant’s pregnancy progressed without concern until she presented to Kingston Hospital at 34 weeks gestation with a history of contractions and back pain. On admission, a CTG was commenced but there was some difficulty locating the fetal heart rate. A portable ultrasound was performed and, whilst the fetal heart rate was located, there was evidence of fetal distress and bradycardia. Terbutaline, which is typically used when there is uterine hyperstimulation, was subsequently administered. The CTG was kept in progress and was reviewed by the registrar on duty who noted concerns with the CTG. A second dose of terbutaline was given as the claimant’s contractions were noted to be increasing in frequency.
The claimant’s condition quickly deteriorated and she became generally unwell. A further ultrasound was performed and sadly an intrauterine death (IUD) was confirmed. A C-section was performed and a large clot was identified, suggestive of a diagnosis of placental abruption which was subsequently confirmed on post-mortem examination.
Following these events, the trust commissioned an internal investigation which identified a number of failings in the care the claimant received when she presented to hospital at 34 weeks. Specifically, it was found that there was a failure to ensure adequate fetal heart monitoring with the CTG; to consider possible causes of an abnormal pre-labour fetal heart rate; to escalate matters to the consultant on duty at the point there was evidence of fetal distress and bradycardia; and to consider urgent delivery in the context of this clinical picture.
Our clinical negligence team was instructed by the claimant to investigate a claim for negligence and, on receipt of supportive expert evidence, prepared and served a formal letter of claim to the trust. A claim was presented on the basis that had matters been appropriately escalated to a consultant following the episode of fetal bradycardia, an immediate decision would have been made to deliver the baby before the claimant was noted to be unwell and her baby would have survived.
The trust carried out its own investigation, and whilst a number of admissions were made in respect of the overall standard of care afforded to the claimant, liability was denied on the basis that the baby had likely already died by the time of her mother’s attendance to hospital due to a concealed abruption and as such no alternative action could have been taken by those treating the claimant to avoid the IUD. We investigated matters further in light of the defendant’s position on causation and obtained further supportive expert evidence from a consultant in fetal medicine, which confirmed that there was evidence that the baby was alive at the time the claimant presented to hospital, and there were missed opportunities to expedite delivery before the baby died in utero. Following receipt of this further evidence, we reverted to the trust to invite it to reconsider its position. However the trust maintained its denial of liability. In view of our robust expert evidence, we were prepared to issue court proceedings but in an attempt to settle the claim amicably and proportionately, we engaged in settlement negotiations with the defendant and it accepted an offer to settle the claim.
Senior associate Amy Milner, who handled the case, said: “This was an extremely sad case of numerous failings by Kingston Hospital following the claimant’s presentation to maternity triage at 34 weeks. Our investigation confirmed there were several stages following her admission when delivery should and could have been expedited such that the subsequent tragic outcome could have been avoided.
“These events have been extremely difficult and distressing for our client and her family who have understandably found it hard to accept that her daughter’s death could not have been prevented. The recovery of damages and outcome of our investigations are small achievements in this tragic case.”