Manzi v King’s College Hospital NHS Foundation Trust [2018] EWCA Civ 1882 (29 August 2018)

This is an appeal… J dismissed a claim for damages for medical negligence… The issue in the case related to the amount of placenta that was retained in the C’s uterus… J held that the placental tissue was not substantial and determined liability in favour of the defendant… (paragraph 1)

On 6 April 2011,C gave birth to H who was her second child. A midwife queried whether the placenta… was complete. There was a suspicion that some of the placenta may have been retained. C was seen by specialist registrar who carried out an examination and an ultrasound scan of her uterus. The discharge summary, completed on 7 April 2011, records that a scan identified a 2cm area of possible placenta left in situ. (paragraph 2)

C was discharged and told that the retained placental tissue should pass spontaneously… Towards the end of that two-week period she experienced pain at such a level that she was admitted to hospital. In hospital an ultrasound scan was performed… recorded “? retained placenta… measuring 7.0 x 2.2 x 4.4cm”. On 21 April 2011 C had placental tissue removed under a general anaesthetic, following which she suffered a haemorrhage. (paragraph 3)

C alleged that D negligently failed to see on the ultrasound scan that a substantial part of the placenta had been retained. As a result… she suffered pain and, on 21 April 2011, had to have placental tissue removed under a general anaesthetic following which she also suffered a distressing haemorrhage… (paragraph 4)

D accepts that a small piece of placenta may have been retained after H’s birth, but says that it was not substantial. What was removed on 21 April was a small piece of placental tissue together with blood which had clotted and accreted around it… D says, there was no negligence… Alternatively, if that is wrong, and D should have identified that a substantial piece of placenta remained in C’s uterus, it is not accepted that C would have agreed to undergo another operation to have it removed so soon after she had given birth when there was the possibility that even a substantial piece of retained placenta would have passed without medical intervention. (paragraph 5)

The parties agreed before the judge that the critical issue of fact determining liability was whether the piece of placenta that was retained after the claimant gave birth was substantial or small i.e. about 7cm or about 2 cm in length. (paragraph 6)

Appeal dismissed (paragraph 33)