Unpredictable rupture

A 32-year old patient booked as a private patient under a consultant obstetrician, an MDU member, for her fourth pregnancy. She had previously had two deliveries by forceps followed by one spontaneous abortion. Her past history also included a laparoscopy for secondary infertility three years prior to this pregnancy.

Apart from one admission with a raised blood pressure of 160/90 at 30 weeks gestation, which settled without treatment, the antenatal course was uneventful. However, two weeks before her due date the patient was admitted with a history of headaches, proteinuria and a blood pressure of 160/110.

The consultant examined her and decided to induce labour. She gave the patient 1.5 mg of prostaglandin and five hours later contractions had started so she was transferred to the labour ward. Within 20 minutes the patient was fully dilated and pushing and as there was evidence of foetal distress, the consultant carried out a forceps delivery.

The baby required intubation and ventilation but quickly recovered. The mother suffered a postpartum haemorrhage which failed to respond to conventional treatment. Laparotomy revealed a ruptured uterus and a hysterectomy was carried out. The patient required 12 units of blood along with fresh frozen plasma and four litres of fluid.

Three years after the delivery the patient brought a claim against the consultant, alleging that the labour should not have been induced. It was as a result of the consultant’s negligence, she alleged, that her uterus was ruptured and she required significant surgery, with consequent psychological damage because of loss of fertility and abdominal scars.

The claim was valued at approximately £75,000, mostly relating to pain, suffering and scarring plus a small claim for care when she returned home and assistance with child care. There was no evidence to substantiate a claim for ongoing physical or psychological injury.

The MDU received expert opinions from two obstetricians who were supportive of the member’s actions. Both experts agreed that the member’s decision to induce labour using prostaglandin was reasonable. The patient was monitored throughout her labour and the experts felt that the rupture could not have been predicted. Both experts advised that the diagnosis was made promptly and the correct treatment instituted.

On the member’s behalf, the MDU denied liability and the claimant’s solicitors later confirmed that they were no longer instructed to pursue a formal claim against the obstetrician.

This page was correct at publication on 01/08/2012. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.