The mother's pregnancy went two weeks beyond term and she was admitted to hospital for induction of labour. A CTG monitor was used to monitor her contractions and the baby's heart rate and syntocinon was used to speed up the labour.
A midwife initially noted 'Good resting tone therefore syntocinon increased to 50mls/hour'. Later she noted that the baby had a slightly reduced heartrate and the plan was to observe. However, the syntocinon infusion was increased. The increased syntocinon on both occasions caused over-contraction of the uterus and, as a result, the baby's heartrate began to drop.
By this time, the mother was found to be 4cm dilated. The membranes were ruptured and the midwife noted that the baby's heartrate improved following the examination. Syntocinon was reduced to 30ml/hour; however, the midwife recorded a plan to increase syntocinon slowly, despite the baby's negative response earlier. No action was taken to increase the mother's fluid intake to ensure she remained hydrated.
As planned, syntocinon was then gradually increased and the baby's heartrate began to drop again. Syntocinon was reduced and a doctor was asked to review. The CTG was categorised as 'suspicious'. The plan was to continue the syntocinon. At 10:30, the doctor noted the CTG was 'better than before', however, the mother remained dehydrated.
When the mother was 7-8cm dilated, the midwife noted that the doctors advised to 'keep increasing syntocinon'. The CTG again showed a deterioration in the baby's heartrate but the syntocinon remained at 100ml/hour until delivery.
Once she was fully dilated, the mother was also found have a temperature of 38.6 degrees. She was treated with paracetamol, ice cubes and a fan but her temperature increased to 39 degrees. A junior doctor advised intravenous treatment with the antibiotic cepedrine, and a reduction of syntocinon.
At this point, a consultant should have taken over the care and a plan for delivery should have been discussed. Cepedrine should not have been used as a first line antibiotic. Fetal blood sampling was ordered but was not carried out.
On advice, the mother commenced active pushing. The midwife noted that the CTG showed the baby had a fluctuating heart rate. Although contractions continued, the delivery was not advancing. A doctor attended and attempted a ventouse and forceps delivery, both of which failed. Another doctor attended and found fresh meconium, a sign the baby was in distress. However, there was a delay in the transfer to theatre and in delivering via C-section.
The baby was born in poor condition and suffered brain injury. He now lives with some impairment of fine motor skills and has a significant learning difficulty. He also has a speech and language difficulty and epilepsy. He will always require 24-hour care.
Liability was admitted by the Trust in pre-action correspondence. At a joint settlement meeting in July, a lump sum payment of £4m was agreed plus annual payments for care and case management for the rest of life, amounting to a capitalised sum of £14.5m, equivalent to £18.5m.
The claimant was 21 years old by the time the claim was approved. His claim was initially run and then abandoned by a previous solicitor. Claire took over the case and settled.
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