The Claimant had not established that the negligence of a staff obstetrician in failing to continue or carry out a further cardiotocograph scan was the cause of her brain damage at birth - McCoy v East Midlands Strategic Health Authority 18.01.11
The Claimant claimed damages from the Defendant health authority for alleged clinical negligence in failing to carry out further cardiotocograph (CTG) monitoring on her mother whilst she was pregnant with the Claimant. The Claimant, who was born on 22 March 1993 at 39 weeks gestation (and who was 17 at the time of the hearing), suffers from diplegic cerebral palsy, which affects her legs, mobility and balance. She also has learning difficulties.
At 38 weeks gestation, the Claimant’s mother complained of reduced foetal movements and was advised to attend hospital for monitoring. A CTG trace was recorded for 58 minutes. This was reviewed by a staff grade obstetrician, who concluded that it was satisfactory . The Claimant’s mother was sent home with a kick chart to record foetal movements.
The Claimant contended that: (1) the obstetrician had negligently interpreted the CTG trace as satisfactory when he had insufficient information to conclude this; (2) the trace should have been continued or a further trace undertaken; and (3) if a further CTG scan had been performed, it would have had suspicious features and prompted delivery before hypoxia caused any brain damage.
The medical experts agreed that the Claimant’s brain injuries were caused by chronic partial hypoxia due to a failure of the placenta. It was likely the damage was sustained after 17 March, but before the Claimant’s mother's admission to hospital on 21 March. The experts also agreed that there were possible decelerations, one being at the very end of the trace, but it was not clear whether the foetal heart rate had returned to normal before the CTG was discontinued.
(1) The obstetrician had acted negligently in forming a view that the trace was satisfactory without clear evidence of whether and, if so, when the foetal heart rate returned to normal after a possible deceleration of some 15 seconds before the CTG was discontinued. However, the Claimant had not established on the balance of probabilities that the trace was suspicious, nor had the Defendant established that it was reassuring.
(2) The nature of the brain injury sustained by the Claimant indicated that damaging hypoxia was not present on 17 March and it was likely that the brain injury was sustained within 24 to 48 hours of her birth on 21 March. On the balance of probabilities, the Claimant had not established that CTG monitoring on 17 March would have shown suspicious or pathological features, thus prompting an obstetrician to deliver her sooner. Therefore, the Claimant had not established that the negligence of the obstetrician in failing to carry out further CTG monitoring on 17 March had caused her injuries. Accordingly, the Defendant was not liable.
This case highlights the importance of caution in interpreting antenatal CTG traces. Whilst the presence of decelerations on a trace does not automatically make it “suspicious”, particularly if accelerations are also present (as was the case here), it is important to continue monitoring the foetal heart if there is any doubt about foetal well-being.
The case also demonstrates that a claimant must establish a firm causal link between further monitoring and a better outcome.