Liability settlement and £250,000 interim payment for child with cerebral palsy from hydrops fetalis

Boyes Turner’s cerebral palsy solicitors have secured a liability judgment and £250,000 interim payment for a severely disabled child in a hydrops fetalis cerebral palsy birth injury claim.

Failure to follow up intrauterine growth restriction (IUGR) on antenatal ultrasound scan

Our client was his mother’s third child and her pregnancy was assessed as low risk for midwifery-led maternity care. Routine scans early in the pregnancy were normal until her antenatal clinic visit at 34 weeks, when the symphysis fundal height (SFH) (used to measure and chart the growth of the unborn baby during pregnancy) was found to have reduced significantly. Our client’s mother was referred for an ultrasound scan and told to monitor her baby’s movements. After a week-long delay, an ultrasound scan revealed that the baby’s estimated fetal weight was below the 5^th centile. Despite these findings, no action was taken to carry out an umbilical artery Doppler scan or to have the mother reviewed by an obstetrician or midwife.

The mother was next seen in the antenatal clinic at just over 36 weeks and reported that she had felt a reduction in her baby’s movements over the last few days. The maternity staff noted that she’d had an ultrasound scan after concerns about the baby’s growth, and that intrauterine growth restriction (IUGR) had been found on the scan, but the sonographer had not advised that any follow up was required, no follow up had been arranged and no Dopplers had been carried out. The records noted plans for a consultant appointment as soon as possible. CTG monitoring of the baby’s heart rate was performed but considered to be normal, and she was advised to attend twice weekly for further CTGs but this was subsequently cancelled by the registrar who advised she attend her next scheduled antenatal appointment in four days.

Ultrasound scan at 39 weeks reveals hydrops fetalis

Our client’s mother attended two further antenatal clinic appointments over the next few days at just under, and then just over, 37 weeks of pregnancy, and the baby’s small size and IUGR were noted on both occasions. A further ultrasound scan took place 11 days later, which revealed that the baby was suffering from the dangerous condition, hydrops fetalis. After further tests for infection, Rhesus antibodies and CTG fetal heart rate monitoring, the mother was reviewed by a consultant who noted the history of reduced fetal movements, the ultrasound findings of fluid in the baby’s chest and abdomen (indicating hydrops) and fetal heart rate abnormalities on the CTG. She was then seen by another consultant and the baby was delivered urgently by caesarean section.

The baby was born in poor condition with moderate acidosis (indicating a lack of oxygen). He was transferred to the neonatal unit and was given oxygen by continuous positive airway pressure (CPAP). An MRI scan revealed that he had suffered a brain injury. He developed four-limb cerebral palsy with significant neurodevelopmental disability.

Claiming compensation for cerebral palsy birth injury

We helped the child’s family pursue a birth injury claim on the basis of our medical experts’ opinions that our client’s injury would have been avoided by earlier delivery if the maternity team had correctly followed up the concerns about his restricted growth (IUGR) earlier in the pregnancy. Our experts believed that correct follow up of the fetal warning signs with scanning and earlier delivery would have avoided the injury which occurred just 2-3 days before the eventual caesarean section delivery at 39 weeks. If the maternity staff had complied with standard RCOG guidance, delivery would have taken place by 37 weeks at the latest.

NHS Resolution admit negligence but deny causation

NHS Resolution responded to the claim by admitting the negligent failure to follow up the ultrasound finding of abnormal fetal growth with further scanning and immediate obstetric review.  They denied that correct action would have led to delivery in time to avoid our client’s injury, which their experts said must have occurred before 34 weeks of pregnancy, given the presence of periventricular leukomalacia (PVL). However, as the case progressed, it became clear that their experts’ reports failed to consider important references in the neonatal records to abnormal pre-birth Doppler scan findings which supported our client’s case on causation.

NHS Resolution also attempted to defend the claim on the basis of an alternative genetic cause for the child’s disability, but were unable to produce any evidence to substantiate that aspect of their defence.

Liability settlement and £250,000 interim payment

We prepared the case for a liability trial but secured a 90% liability settlement for our client at a round table meeting (RTM) with NHS Resolution shortly before the scheduled trial. The settlement guarantees our client substantial compensation to meet his extensive lifelong needs, whilst removing the litigation risk of a contested trial. Our client’s immediate needs will be met by a £250,000 interim payment whilst we work with the family and our experts to value the claim.

The family’s privacy is protected by an anonymity order.

If your child has cerebral palsy or neurological disability as a result of medical negligence, or you have been contacted by HSSIB/MNSI or NHS Resolution, you can talk to a solicitor, free and confidentially, for advice about how to respond or make a claim by contacting us.