Postnatal pulmonary embolism

A consultant obstetrician member of the MDU received a letter of claim from solicitors instructed by a former patient.

The patient had been pregnant with her first child, and saw the consultant privately for antenatal care. She was aged 34 and generally fit and well, other than having had a DVT several years earlier following a fractured ankle. The consultant arranged thrombophilia testing, which was negative.

As part of the patient's routine antenatal care, the obstetrician documented a thromboprophylaxis risk assessment, and decided that given her history of a previous DVT, she should have post-natal prophylactic low molecular weight heparin for six weeks.

The pregnancy was uneventful, and the baby born by spontaneous vaginal delivery. The patient was discharged home the day after delivery, but did not receive low molecular weight heparin, as had been planned. Three days after discharge, she was readmitted with shortness of breath.

The consultant immediately suspected a pulmonary embolism, and arranged a CT pulmonary angiogram which confirmed the diagnosis. The patient was treated with low molecular weight heparin, followed by warfarin for six months, and made a good recovery.

The patient was discharged home the day after delivery, but did not receive low molecular weight heparin, as had been planned.

In the letter of claim, it was alleged that, contrary to her antenatal care plan, and contrary to guidelines issued by the Royal College of Obstetricians and Gynaecologists, the claimant did not receive postnatal thromboprophylaxis, as a result of which she suffered a pulmonary embolism.

The MDU obtained expert advice from an independent obstetrician, who confirmed that the failure to prescribe postnatal thromboprophylaxis was a breach of duty of care. Expert advice from a haematology expert was also obtained, which confirmed that had low molecular weight heparin been prescribed following delivery, the pulmonary embolism would have been avoided.

In the light of the expert advice, and with the consent of the MDU member, this claim was settled. The MDU paid damages to the claimant of £25,000, and her solicitor's fees of £18,000.

Dr Claire Wratten
Senior medical claims handler

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