UK: Medical Records - Investing In The Future

Last Updated: 1 March 2001
Article by Clare Jaycock

Claims arising from pregnancy and childbirth have consistently formed the largest proportion of cases brought against the medical profession. A selection of recent cases shows the importance of good record-keeping when considering medical decisions taken in extremis.

In Martin v Norfolk and Norwich Healthcare NHS Trust 1 the Claimant, who was born in 1989, suffered dystonic cerebral palsy resulting from acute asphyxia within the half hour before birth. The asphyxia had been caused by a placental abruption, namely a breaking away of parts of the placenta from the uterine wall, thereby reducing foetal blood supply. The claimant alleged that the midwives had negligently failed to detect or respond to the abruption or its warning signs, and that an earlier caesarean section would have avoided injury.

The claimant was delivered at 13.43 hours and it was alleged that the mother had suffered continuing vaginal bleeding from 11.50 hours, at which time a doctor should have been called. The judge had to deal with conflicting factual evidence, but held that there was no significant bleeding or pain before 13.00 to 13.10 hours when a doctor was called. Furthermore there had been no warning signs to alert the midwives or the obstetrician to the possibility of placental abruption. The midwives had responded appropriately and at the right time.

In a very similar case also heard in January this year, Wood v North Durham Acute Hospital NHS Trust 2 the court had to consider negligence following placental separation at birth which left the claimant with severe cerebral palsy.

The claimant was born by a breech delivery in 1989. Progress was satisfactory until 10.30 hours when the buttocks crowned and fetal scalp electrode (FSE) monitoring ceased. Hypoxic insult was suffered between then and delivery at 10.43 hours.

The claimant alleged that the FSE should have been reapplied in which case fetal distress would have been noted and the delivery expedited. The court held that the requirement for monitoring would depend on the circumstances of the case. There was no general obligation to reapply a FSE once this had become detached. In the absence of signs of fetal distress, it was accepted practice in 1989 to allow up to ten minutes for a breech birth baby to be delivered. The obstetrician had to balance the risks of interfering and causing damage against the rare risk of premature placental separation. The claim was not upheld.

Cases can turn on very fine timings, not only on the question of causation, namely whether less damage would have been sustained had delivery been achieved earlier, but also on liability. It is for this reason that CTG trace evidence can be crucial. In the case of Simms v Birmingham Health Authority 3 the claimant was born on 4th March 1982 at 12.58 hours in a severely asphyxiated condition. He was subsequently diagnosed with cerebral palsy and it was accepted by both sides that damage had been sustained by 12.30 hours. It would have been necessary to order a caesarean section by 11.30 hours.

There were no CTG traces for the period from 9.20 hours to 11.05 hours. The court held that the CTG trace from 11.05 hours showed reduced baseline variablity and that there would probably have been a similar pattern from 10.30 hours. There were continued decelerations and a caesarean section should have been ordered by 10.30 hours. The court found in favour of the claimant.

The common theme running through all these cases is the need to make and keep fully documented notes and records. Midwives and obstetricians are often required to make vital decisions and assessments under pressure in the knowledge that these can have far-reaching implications for the pregnancy and the new-born child. In situations of such high tension, there is a natural tendency to pay less attention to documenting the decisions which are made. Childbirth claims can be brought many years after the birth took place. The clinicians may no longer be traceable and those who are will have difficulty recalling the events which took place. Written notes, made as close to the event as possible, can make all the difference at court. It is vital that such notes are made and efficiently collated and stored. Time invested now on good record keeping will bring dividends in the future.


1 LTL 31/01/2001

2 LTL 24/01/2001

3 LTL 11/01/2001

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

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