From 36 weeks gestation, A's mother was in discomfort carrying her twins, each of which likely weighed over 6lbs at that stage. At 37 weeks, she was seen at the hospital for a routine appointment but not offered an early induction of labour, or further review appointments. She was eventually offered an appointment to consider induction to take place at 42 weeks + 3 days but had already been admitted to hospital the previous day because she had gone into spontaneous labour.
After the first twin was delivered, A, the second twin, was found to be in the breech position and several unsuccessful attempts were made turn A by external manipulation before this was abandoned and an emergency caesarean section had to be performed.
During the manoeuvres to try to turn the baby, performed on the labour ward, insufficient attention had been given to the baby's heart rate and when this was eventually checked, it was found to have dropped to dangerously low levels due to lack of oxygen. The heart rate was even lower than actually written in the notes, due to a mistake in the recording. The caesarean section was further delayed until the mother could be transferred to theatre for a general anaesthetic. A was eventually delivered white due to asphyxia. No paediatrician was in attendance at delivery and the baby did not breathe spontaneously until seven minutes after delivery. At one hour of age, A was transferred to a different hospital for cooling.
Allegations of negligence against the hospital were based on their management and care, including
- failure to offer the mother the option of an elective caesarean
- failure to advise on the risks of continuing labour to term and beyond
- failure to devise and implement a plan to stabilise A to prevent him from becoming breech
- failure to react to the drop in his heart rate and failure to proceed to emergency caesarean.
Baby A's brain damage resulted from placental separation or alternatively by cord entanglement when external attempts were attempted to rotate A. Had A's mother been made aware that she could have elected for an induction at 38 weeks, she would done so and both twins would likely have been born uninjured.
The defendant refused to admit fault so that the claim for liability for the injuries was eventually settled following several steps in the litigation. The Court eventually approved settlement of 95% of all damages due, once these could be quantified with expert evidence. Meanwhile, interim damages paid by the defendant funded private care and therapy.
Exert evidence led to settlement being agreed, subject to the court's approval, just prior to trial which will provide suitably adapted accommodation and ensure A receives care and therapy for life. It will also provide compensation for the likely loss of earnings, fund the appointment of a professional trustee and a case manager to support the team of carers and therapists throughout A's life.
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