Stillbirth at Bournemouth Hospital following failure to recognise obstetric cholestasis
This was Sophie's second pregnancy. She had been classified as high risk due to her previous pregnancy, and was told she would be under consultant-led care. She had no problems in the initial antenatal period, but in her third trimester, Sophie began to experience itching on her abdomen, reduced fetal movements, severe exhaustion, slurred speech and nosebleeds, which she reported to the midwives. These were not recorded in her notes, and not recognised as symptoms of obstetric cholestasis (OC), which should have been followed up.
Sophie's pregnancy and symptoms continued, and she attended her final antenatal appointment two days before attending hospital for delivery at 38 + 2 weeks. She was reassured, advised fetal movements could be felt, and told to attend hospital on her due date.
Sophie called the hospital when she began to have contractions, and reduced fetal movements. She was advised to stay at home and have a cold drink. She called again before attended hospital shortly afterwards. Unfortunately, when monitoring began, the doctors and nurses were unable to find a heartbeat, and Sophie was told her daughter would need to be delivered stillborn. Bournemouth Hospital had limited facilities, and so she was transferred to Poole Hospital by ambulance where she later gave birth.
Post-delivery, Sophie underwent tests, and was diagnosed with a condition called obstetric cholestasis (OC). She was seen by a specialist consultant, who confirmed that her daughter's stillbirth was caused by asphyxiation due to the OC. The hospital trust began an internal investigation to find out what had gone wrong. Despite reports that the treating consultant had concluding that blood tests should have been requested, this was not included in the report given to Sophie.
Sophie wrote to the hospital prior to contacting solicitors, explaining the symptoms she had reported, and questioning why these had not been followed up. The response acknowledged she had reported symptoms of itching, but did not consider this a 'classic' symptom that required follow up.
Sophie contacted Arti Shah to investigate a medical negligence action after a recommendation from a family friend. After obtaining expert evidence, Arti alleged that there had been a failure to consider and follow the defendant's own Obstetric Cholestasis (OC) pathway. Sophie should have undergone blood tests, including liver function and bile tests. Had such tests taken place, the results would have been abnormal, and Sophie would have been monitored under the OC pathway. She would have been offered induction of labour, which she would have accepted, and her daughter would have been born alive before 38+4 weeks.
The defendant denied liability throughout, seeking to rely on a treating obstetrician's opinion, despite Sophie having consulted a leading world specialist who confirmed her diagnosis of OC. The defendant also considered it inappropriate to need expert evidence from a hepatologist/gastroenterologist, despite the condition involving liver condition and bile test results. Several interlocutory hearings were needed throughout the case to deal with various issues raised by the defendant.
The defendant's approach meant that Court proceedings had to be issued and served, and expert evidence exchanged in relation to liability. No offers were forthcoming from the defendant.
The case continued, and shortly before service of the defendant's quantum evidence, the parties were able to reach agreement, three months prior to trial.
At the end of the case, Sophie said:
"Losing our daughter was the worst thing ever to happen to us and as we lay in hospital, we felt something could have been done to prevent this outcome.
"We tried talking to the doctors but felt unheard. Seeking legal counsel was not something that came naturally to us but we were lucky to have Arti recommended to us. From the initial meeting we felt at ease talking to Arti, and that we were doing the right thing. Arti was the right level of personable and professional and it felt like working with a colleague. The rest of the FF team were amazing too, attentive and responsive at all times. Working with FF made a bad thing good and by settling our case, we finally feel heard."
*name changed
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