Sanderson v Guy’s And Thomas’ NHS Foundation [2020] EWHC 20 (QB) (10 January 2020)

C suffers…from cerebral palsy. Her injuries were caused by a short period of acute brain hypoxia in the minutes preceding her delivery at 01.05 on 26 February 2002. The questions for me in this trial have been whether there was any breach of duty by the consultant obstetrician caring for C’s mother in her second stage of labour and if so whether, but for that breach of duty, C’s delivery would have taken place earlier such that the period of hypoxia would have been avoided or shortened. [1]

C’s case focuses on the decisions made by D consultant obstetrician between 00.40 on 26 February 2002 and the Claimant’s delivery 25 minutes later, at 01.05. [3]

C’s mother was 37 years old at the time of her pregnancy with C in 2001. The pregnancy was uneventful and she was admitted to hospital with irregular contractions at 17.13 on 24 February 2002. The first stage of labour was prolonged by a long latent phase and failure to progress. [6]

the night of C’s delivery was exceptionally busy. Both obstetric theatres were occupied and the labour ward rooms were all full. [8]

C makes two main allegations, each freestanding. [25]

The first allegation is directed D’s decision to perform a fetal blood sample following her assessment between 00.40 and 00.48/49. C’s case is that the CTG demonstrated a prolonged deceleration between 00.38 and 00.43 which continued over three contractions. It is alleged that this feature was a sign of acute fetal compromise and, as such, the only reasonable management was immediate and urgent instrumental delivery of C… C alleges that D’s finding on vaginal examination of a fixed head did not reasonably indicate that instrumental delivery would be difficult or impossible [26]

The second allegation focuses D’s management following her return with the fetal blood sample equipment and her finding that the fetal heart trace had deteriorated to the extent that there was now a bradycardia. C’s pleaded case that the bradycardia started at 00.47. Upon D’s return at around 00.53 therefore the bradycardia had been ongoing for 5 minutes. Urgent delivery was mandatory. It is alleged that, overall, the interval of time between D’s return at 00.53 and her starting the delivery at 00.59 was too long. Acknowledging that there was a need to obtain the essential equipment for the delivery, it is contended again by C that D should have delegated the task of obtaining the equipment to others and that her absence for around 3 to 4 minutes (between 00.54/55 and 00.57) was excessive given the bradycardic trace and the risk of hypoxic brain injury. The sort of inquiries which she needed to make should have been completed within seconds and not minutes. [28]

Both allegations are disputed by D. Put shortly, the Defendant disputes that there was an indication for urgent delivery following D’s first review between 00.40 and 00.47/48. It denies that there was any delay in performing the instrumental delivery following her return around 00.53 or at all. [29]

timeline of events under scrutiny.

00.40 D is called and arrives in Room 4
00.48/49 D leaves Room 4 to obtain equipment for fetal blood sample and make inquiries concerning theatre availability and Room 18
00.53/54 D returns to Room 4 and notes bradycardia
00.54/55 D makes decision that delivery should be undertaken urgently, the Syntocinon is switched off and D leaves Room 4 for the second time, to get the equipment for an instrumental delivery and to make inquiries concerning Room 18.
00.57/58 D returns to Room 4
00.58/59 D makes decision to deliver in Room 4 and prepares for instrumental delivery
00.59 D starts instrumental delivery
01.05 C delivered

D’s decision to perform a fetal blood sample was reasonable. It was a decision which would be supported by a reasonable and responsible body of obstetricians. It was not illogical but based upon a reasonable assessment of the fetal heart trace which, although pathological, did not indicate the need for urgent and immediate delivery. Her decision to temporise and obtain a fetal blood sample to assess whether C was acidotic due to hypoxia was supported by her reasonable belief that proceeding immediately to delivery in [first stage room] carried an unacceptable risk of injury or death to C. [93]

D acted as quickly as she could to achieve all that was required during her second departure in conjunction with my reasoning in dismissing the allegation of delay during D’s first departure is sufficient to dismiss C’s further argument on delay during D’s second departure from the room. [101]

claim dismissed [109]