Seven-figure settlement secured for failure to diagnose and treat post-partum haemorrhage
A young woman has been awarded substantial damages following failings in her maternity care during and after labour at Royal Preston Hospital (part of Lancashire Teaching Hospitals NHS Trust). She suffered a significant and life-threatening post-partum haemorrhage and subsequently suffered severe post-traumatic stress disorder.
A post-partum haemorrhage (PPH) is very heavy vaginal bleeding occurring after childbirth and is categorised as blood loss of 500ml or more in the first 24 hours after childbirth. PPH is a medical emergency, posing a significant risk to the mother’s health. It can cause a sharp decline in blood pressure, restrict blood flow to the brain and other organs, and lead to haemorrhagic shock, which can be fatal.
Our client was pregnant with her second child and had been assessed as a low risk patient suitable for labour in the birthing centre at Royal Preston Hospital. Her antenatal care was uneventful, other than a low lying placenta on the 20-week anomaly scan. This was checked at 32 weeks, and again at the 36 weeks scan, and subsequently deemed to be a safe distance away from the cervix.
She attended the birth centre as her membranes ruptured, and she was experiencing contracting. On admission at 21:05, she was noted to be draining copious liquor and contracting 2-3 in every10 minutes. A vaginal examination showed that the cervix was 3-4cm dilated. The birthing pool was filled as requested.
Our client was using Entonox (gas and air) in the pool and at 22:25 she had paracetamol for pain relief. She started to have an urge to push around 22:40. This continued but there were no external signs of full dilatation, so she was encouraged to breathe through the contractions.
At 00:45 the urge to push was increasing, but as delivery was still not imminent by 01:15, the midwife planned to offer a vaginal examination at 01:45 to assess progress.
The midwife noticed blood loss in the pool when pushing. She asked for a second midwife’s opinion and was reassured it was normal and safe to proceed, but to observe loss. It was our client’s evidence that the blood loss was significant and included clots, with increased blood on pushing.
Our client’s son was safely delivered at 01:52. Large clots were passed with significant blood loss noted on the floor. Despite active management of the third stage of labour, the placenta was not delivered until 51 minutes later, with further blood clots and increased blood loss.
Our client reported feeling faint and required transfer to the delivery suite for further review. Total estimated blood loss at this time was noted to be approximately 1000mls (ie one fifth of average adult blood volume). Despite excessive blood loss, a major obstetric haemorrhage (MOH) call was not raised to summon senior input and obstetric assistance.
On transfer to the delivery suite, our client was noted to be hypotensive (low blood pressure), tachycardic (high heart rate) and in clinical shock secondary to blood loss. Poor attempts were made to resuscitate her in the delivery suite with intravenous fluids only.
She continued to be managed by a junior doctor and there were delays in transferring her to theatre for an examination under anaesthetic and surgery to stem the blood loss. There was a notable lack of senior oversight in her care and management whilst she was critically unwell.
Our client was ultimately transferred to theatre at 05:30, at which point a MOH call was put out to summon senior assistance. She required further stabilisation in theatre before she could be anaesthetised, during which time she experienced fluctuating levels of consciousness and awareness.
At the point of surgery, her total blood loss was estimated to be 1800ml, although it was documented in her medical records that it was considered to be significantly under-estimated due to the severity of her clinical condition.
Our client went on to make a good physical recovery and was discharged within two days. However, she experienced significant psychological trauma and was subsequently diagnosed with severe post-traumatic stress disorder and a moderate depressive disorder. Her PTSD dominated her life such that her symptoms were triggered by bleeping sounds and fluorescent lighting. She was unable to return to her previous employment as a frontline police officer and was ultimately retired on grounds of ill-health.
Penningtons Manches Cooper was instructed in 2022. We proceeded to obtain supportive expert evidence from specialists in obstetrics, gynaecology and psychiatry.
Our obstetric evidence identified numerous failings in the maternity care provided to our client, including failure to:
There was also excessive use of uterotonics without an examination under anaesthetic and the documented cause of her post-partum haemorrhage.
The defendant accepted in pre-action correspondence that there had been failings in our client’s case, namely that there had been a failure to accurately record blood loss and delays in transferring her to theatre by approximately two hours, during which time she continued to bleed and deteriorate clinically.
However, the defendant argued that despite these failings, our client would have experienced an extensive post-partum haemorrhage in any event, and disputed that her outcome would have been significantly different with earlier management.
We relied on expert psychiatric evidence obtained in support of our client’s claim, which confirmed that the major causative event giving rise to her PTSD and depression was the period between her transfer to theatre and her delayed anaesthetisation, where she experienced terrifying memories of lying in the operating theatre, semi-conscious and unstable, and fearing that she may die.
The defendant ultimately admitted that had treatment been carried out sooner, our client’s condition would not have progressed to the extent that it did, and she would have avoided significant psychiatric injury.
Additional evidence was obtained from a forensic accountant to assess the significant loss of earnings and pension sustained by the claimant on account of her ill-health retirement. It was acknowledged that following an extensive period of psychiatric treatment, our client would be able to return to employment, albeit in a reduced capacity, on a lower salary, and she would likely require retraining.
Following early exchange of expert evidence in December 2023, a round table meeting was held in June 2024. The parties reached a final conclusion in the days following the meeting, securing a seven-figure settlement for our client, including recovery of substantial past and future psychiatric treatment and loss of earnings and pension.
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