Damages for psychiatric injury following mismanagement of young woman’s miscarriage

Case Studies

Damages for psychiatric injury following mismanagement of young woman’s miscarriage

A young woman has been awarded damages following the failure of an NHS trust to appropriately manage her miscarriage, which saw her suffer a traumatic incident involving severe vaginal haemorrhaging and extreme abdominal pain, resulting in a psychiatric injury.

The woman fell pregnant with her first child in 2017. She began to experience minor cramping and bright red spotting. She was referred by her GP to the local Early Pregnancy Assessment Unit (EPAU) and underwent an internal and external ultrasound scan. Following this, she was informed that she was experiencing a miscarriage and told to let nature take its course.

Ten days later, she returned to the EPAU and underwent another ultrasound scan. She was informed that she was experiencing a delayed miscarriage and that retained products of conception (RPOC), ie fetal or placental tissue, were still present within her uterus. She was presented with different treatment options and opted for medical management, which involved inserting a pessary into her vagina. 

Around two weeks later, the woman returned to the EPAU and underwent a further ultrasound scan. She was informed that RPOC were still present in her uterus and was offered surgical management or another round of medical management. She opted for surgical management and was listed for an Evacuation of Retained Products of Conception (ERPC). A few days later, she attended the EPAU to undergo the ERPC and was advised after the procedure that she should expect some bleeding, akin to a period, but that this should resolve within seven days.

In the week that followed, the vaginal bleeding increased. Sensing something was not right, the woman called the EPAU and spoke with a nurse. She explained that she was concerned by the fact she was still experiencing severe abdominal pain and very heavy vaginal bleeding, necessitating changing sanitary towels every 30 minutes. She also explained that she had taken a pregnancy test and obtained a negative result. She requested another scan but the nurse informed her that this was unnecessary. The nurse advised that pain and bleeding was to be expected after surgery and that it was likely she was simply having a period. 

Around two weeks later, while on a respite holiday with her partner, the woman was sitting in a public place when she experienced an intense contraction-like sensation. She then felt a substantial amount of blood haemorrhaging from her vagina, which soaked her trousers. She ran back to her accommodation and resorted to standing in the shower, while her partner called 999. She was terrified she was bleeding to death. 

Around 45 minutes later, paramedics arrived and the woman was taken to hospital, where she underwent a USS which revealed she still had a large amount of RPOC present in her uterus. She was advised she needed to undergo another ERPC. After the second ERPC surgery, her bleeding quickly began to ease.

Following a few weeks of recuperation, she felt physically recovered but was left psychologically traumatised and suffered with debilitating anxiety. Every time she stood up, she feared she would experience a contraction-like pain and begin to bleed profusely. This psychiatric injury required a course of therapy and took over two years to resolve.

Our clinical negligence team was instructed to act on the woman’s behalf. Following receipt of medical expert evidence from an obstetrician and gynaecologist, it became clear that when she phoned the EPAU following her first ERPC, there had been a failure on the part of the nurse to consider that her symptoms might not be attributable to her period returning, and to advise her to go back to the EPAU for an ultrasound scan to rule out other possible causes (ie further RPOC, as was in fact the case). Had she returned for an ultrasound scan (which would have diagnosed further RPOC), she maintained she would have opted for a second ERPC procedure at that point, which would almost certainly have avoided her experiencing the severe haemorrhaging while on holiday which resulted in her psychiatric injury.

Initially, the hospital denied any liability for the psychiatric injury and refused to enter into settlement negotiations, arguing that the nurse had provided appropriate advice when the woman phoned the EPAU to express her concerns following her first ERPC. However, we were able to make the hospital reconsider its position by serving a letter of rebuttal, using evidence produced by our medical expert and by referring to relevant medical guidelines. Ultimately, we convinced the hospital to engage in negotiations to settle the claim for a considerable sum without issuing court proceedings. 

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