Barts Health admits negligence in twin birth injury

The baby's mother, Helen*, instructed Caron to pursue a claim after she received a report from the Trust advising it may have caused her son an acute kidney injury on the NICU ward (neonatal intensive care unit).

Around 20 minutes after his birth, one of the twins, James*, was found pale, bluish in colour, and grunting. He had suffered an acute intertwin fetal haemorrhage during delivery, which led to respiratory collapse. The haemorrhage caused fetal Hypovolemia and anaemia. He was transferred to the NICU, where a further injury occurred due to failure to recognise and treat dangerously low blood pressure. These combined events caused a permanent bilateral acute kidney injury.

While the focus of the Trust's report was on failures of care in the NICU, we also investigated failings in antenatal and labour care.  Helen, was wrongly advised that her twin pregnancy was dichorionic diamniotic (DCDA) rather than monochorionic diamniotic (MCDA), despite clear indicators to the contrary, which put her on the wrong care pathway.

In MCDA pregnancies, twins share a placenta, which carries a significantly higher risk of serious complications requiring early intervention, including Twin-to-Twin Transfusion Syndrome (TTTS) and Twin Anaemia-Polycythaemia Sequence (TAPS).  TTTS involves uneven blood flow, risking heart failure or death and TAPS causes one twin to become anaemic and the other polycythaemia, often without fluid imbalance, making it harder to detect.

Therefore, being on an MCDA care pathway would have meant Helen would have had increased monitoring and specialised antenatal appointments including serial growth scans and, most importantly, delivery at 36 weeks, via induction or elective caesarean.

Had Helen been correctly advised of these risks, she would have opted for delivery at 36 weeks by caesarean section. Instead, the pregnancy was allowed to continue beyond 36 weeks. The babies were eventually delivered at Whipps Cross Hospital at 38 weeks following induction.

Following completion of our investigations, we served a formal letter of claim, supported by expert evidence and a detailed review of the medical records.

The Trust has now admitted both breach of duty and factual causation. It accepts that the MCDA pregnancy should have been identified and that had appropriate care been provided, James would have been delivered at 36 weeks by induction, and he would likely have avoided the kidney injury.

The Trust also accepts James will require a kidney transplant during adolescence and that his condition will necessitate lifelong immunotherapy, regular monitoring, and potentially multiple transplants over his lifetime.

Caron then secured an initial interim payment of £315,000 for James, who is represented by his mother as litigation friend. He will require a kidney transplant at around 16, with the likelihood of further transplants throughout his life. He will also need ongoing psychological support, as well as other therapeutic input. There will be times when he requires dialysis. His injuries are life changing and have seriously impacted him and his family.

Given the complexity of his prognosis and the evolving nature of his condition, proceedings are stayed until his 14th birthday. This will allow for a more accurate assessment of his long-term needs, including life expectancy, future care and assistance, dialysis and transplant requirements, psychological impact and loss of earnings.

James' parents were both relieved and shocked at the Trust's full admission, given the contents of their internal report, which has made them feel angry that their son has suffered such injuries and incredibly sad at the effect on him and his whole family as they support him. 

They said: 'James' injuries were avoidable. That makes it incredibly difficult to come to terms with what has happened to him and to deal with watching his injuries evolve, knowing all of this could have been different if our maternity team had followed guidelines on diagnosing monochorionic pregnancies correctly. 

'However, knowing there is an admission and that the Trust are willing to pay James compensation means we can do our utmost to provide him with the support and care he will need going forwards to deal with the effects of their negligence.'

*names changed

Contact us

For further information about twin birth injury claims or birth injury claims please call Caron Heyes on 03304606743 or email caron.heyes@fieldfisher.com or please call Louise Astill on 03304606147 or email Louise.Astill@fieldfisher.com

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