To think seven Caesareans in eight years is a recipe for disaster?

[ElizabethG81]

What's happened to this woman is horrific, but surely having so many Caesareans in such a short period of time is recklessness bordering on insanity? www.dailymail.co.uk/femail/article-3615027/Mother-eight-relives-nightmare-waking-C-section-discover-legs-amputated.html

What a nightmare for you! Glad everything's ok now

Am I a hcp? Yes. Unimaginative username

She will not have legal aid it will be a no win no fee ambulance chasing lawyer.

An apology is not an admission of guilt. If you read the letter on the metro link up thread the hospital are careful to say that 'no-one can say' whether missing one set of obs at 3am affected the outcome. Of course they'd say sorry in a meeting like that. They are sorry for the outcome. Any normal person would be sorry but still it might not have been avoidable.

She will have had 1:1 care and continuous monitoring on ITU. I can only imagine that what was missed was a check if her foot pulses at one time point at 3am.

Again it was (confirmed in letter) an arterial thrombosis not a DVT. Pressure relieving boots can do nothing for that. It's not due to immobility. It happened because of clotting derangement due to the multiple transfusions.

What people are missing is the sheer dangerousness of the scenario. She had haemorrhaged nearly her whole blood volume. It's not poor post op care after a routine c-section, of course she'd be right to complain if she woke up minus her legs after that. Do you really think that could happen?? It's a life and death touch and go scenario where she was kept alive but lost her legs.

I wasn't there. I don't know how it went but I can imagine better than most because I have been involved in trying to save people in comparable situations. She will have been the sickest patient in the hospital. So many people were involved trying to save her and the baby. The whole place will have been rooting for her. A young woman who's just had a baby in a life threatening situation- we are human too. I just know how hard everyone would try. It's so unlikely she was just left for hrs with no care.

A bilateral arterial thrombosis is not a foreseeable, easily preventable complication like people seem to imagine. It more commonly happens in elderly smokers where the artery clots off but in this case it was likely DIC due to massive transfusion. Google that and look at the survival rates.

I feel for her of course I do but I also feel for the Drs and nurses who did their very best to save her life and ate now getting sued and bad mouthed in the Fail. They can't give their side due to patient confidentiality.

It makes it seem from the headline and some of you really seem to believe that NHS care is so poor that you are likely to wake up from a c-section minus your legs. Please be reassured that this is not going to happen.

Possibly I am wrong and she has had negligent care but I don't see anything to suggest that from what we know. A bad outcome doesn't mean poor care it can just be bad luck.

I wrote a very long response but in essence - what mamadoc said.

I am not sure what checks they expect to be done with regard to the development of arterial thrombus - the feet would have gone pale and cold, but they are not routinely checked on ICU and are hidden in stockings and calf compressors or foot pumps in any case. There is 1:1 nursing care for any intubated patient and a raft of monitoring that observe vital signs continually (none of which are likely to have been affected by developing lack of blood supply to the lower legs). We don't monitor pedal pulses hourly after massive haemorrhage and massive transfusion, she has just been extremely unlucky.

Even had developing thrombus been picked up, there are only two real treatments; surgery (which she had) or anticoagulation (which no doctor in their right mind would have prescribed after a major haemorrhage and massive transfusion).

This lady, regardless of the difficulty she now finds herself in, had a good outcome. She is alive to be with her family. I have looked after similar cases with similar problems where both mother and baby died - not through any lack of medical expertise, but sheer physiology working against them. I know they are angry and upset, but teams of health care professionals will have worked over and above the usual to try and save her life. To find themselves the subject of a lawsuit now will be very hard for them.

so a really dire situation with an unfortunate outcome?

Just awful really. No ones benefitting here but the lawyers.

I feel so sorry that she lost her legs, but agree her family must be grateful that at least she is alive.

mamadoc

Thanks for the info. If this case saves one other woman from making the same decisions, then it's probably a good thing.

I'm not sure what info doctors give women post c section
But sometimes I think a list of case studies could be helpful? Eg these 8 women had a c section 5yr ago
1 had no more babies
2 had repeat c sections after 2yr
1 had 4 more c sections and complications etc
Sometimes easiest way to explain risk?

foxy I wasn't given any info after my EMCS. I had to ask when it would safe to have a second dc, primarily so I accidentally got pregnant too soon I would know how much to panic. He said to leave it for 6 months. Although I made it a 22 months gap between sections. My body had recovered well, was running and at the gym before I wanted a second pregnancy and major operation to hit my body. That poor woman has barely had time for her body to recover between pregnancies and operations.

With Placenta Accreta she is lucky to have survived as it goes through the womb walls and attaches itself to major organs depending how aggressive it is. I have had 4 c-sections, and the third nearly killed me through having placenta accreta. As I didn't have a baby at the end of it I was desperate to try again even though I knew I was putting myself at risk again but I buried that thought until the last week when they started looking for signs of the accreta again and then I was beside myself with worry. However, if I had woken up to having no legs on either occasion I would have found it difficult to believe and I would be looking for someone to blame because it would seem too incredible for words especially if there was a problem which showed in my notes. It wouldn't have made me any less grateful to the people who saved my life but I would want to know the absolute truth especially as I would have children that would need looking after.

'However, if I had woken up to having no legs on either occasion I would have found it difficult to believe and I would be looking for someone to blame because it would seem too incredible for words especially if there was a problem which showed in my notes. It wouldn't have made me any less grateful to the people who saved my life but I would want to know the absolute truth especially as I would have children that would need looking after.'

So sue them?

Poor poor woman
Whether she was 'foolhardy' or not, no one deserves that

^All operations are a risk. Surgeons should have refused the 4th
never mind the 8th.^

You think they should've obliged her to have a VBA3C, then? I assume you're suggesting this as you think it would be the safer option rather than just to spite her, so what's your basis for suggesting this?

Saramel- you've a right to your own choices and clearly everyone's tolerance of risk is different but I've got to say I find it hard to imagine the mindset of putting oneself through a 4th c-section after the 3rd 'nearly killed me' with the high chance is accreta recurring. I'm guessing that was against medical advice. You had 2 DC already who need you right?

For me that's a risk too far. For you it's not but if something had gone badly wrong you are accepting by going against advice that the NHS may not be able to protect you from the consequences of your choice although we will try.

All operations are a risk. Surgeons should have refused the 4th
never mind the 8th

Another idiotic post. They can't refuse it because once she was already pregnant, yet again, the only thing more dangerous than doing a section was not doing one. Kid has to come out somehow.

I feel sorry for the surgeons being forced into doing surgery that the know is dangerous and ill advised.

I'm also a HCP,

One of the newer treatments for placenta acreta/major Obs haemorrhage is iliac artery balloons. You put these in and blow them up to stop the blood supply to the uterus.

I wonder if she had them put in (one of the experts referred to was an Interventional radiologist - they are the specialty that do these). An arterial thrombus could easily be a very rare complication of an arterial catheter procedure.

We do not have enough info on this thread but she and a condition that carries a high mortality even in the developed world.

Oh and to the person that asked you would normally put these patients to sleep. The last thing you want in the middle of a high risk section like this is a combative patient (hypotension makes you feel awful and can make you act oddly) and a stressed partner. Because you tend not to have a awake Obs patient in thetre without their partner present.

Converting from regional to GA is fairly standard when the beheld is unplanned and starting with a GA when trouble is anticipated isn't unusual

One of my friends had an acreta and after a whole series of herald bleeds had a planned section with iliac artery balloons in under GA. Her husband and Mum said it was the worst afternoon of their life.

Ah ha gasman that is a very good point and quite a likely explanation.

The Metro letter says that they got a 2nd opinion from another interventional radiologist who supported their management which does seem to suggest that perhaps it was a rare complication of that procedure. In which case perhaps checks of her peripheral pulses were ordered post procedure if its a recognised complication and not done. I'm still very doubtful that detecting it earlier would have saved her legs. They'd have needed to operate in any case as she couldn't have anticoagulants and there's no guarantee it would have worked.

I have been puzzling over how you could wind up with bilateral arterial thrombus in both legs in this scenario. Someone else suggested DIC and that did seem plausible but doesn't really explain why it was just her legs.

They will go to court and it will be decided if they were negligent or not. I still feel it's a bit like prosecuting soldiers for shooting people on the battlefield (not quite sure if that's a good analogy. I am thinking of the 'fog of war'). They will have been struggling so hard to save her life and yet there's no recognition or gratitude for that. In that kind of scenario bad stuff goes wrong sometimes without it being negligent or anyone's fault. She did put herself in the high risk situation and therefore some of the responsibility for the tragic outcome is hers.

It is really not entirely psychologically normal to have such a need to have more babies that you put your life and the babies life at ever increasing risk each time. How on earth can the desire to have one more child when you already have 7 be so over-riding that you disregard all the advice and warnings which I am absolutely certain she will have had? There are people who are sort of addicted to being pregnant because of the special status it accords you. There must have been some very deep psychological need she was fulfilling by doing this.

She is lucky to be alive for her family. She was extremely foolish and should be thankful they saved her life!

If there was an omission that would satisfy the test of negligence, the overall case will hinge on the causation and whether the omission in the care was >50% likely to have caused/been a major player in causing the eventual outcome (possibly consent, but hard to see how this could have been managed any differently) overall the outcome's pretty good - mother and baby are alive - but if the loss of her legs was avoidable and caused by a failing in the care -if- then it's right for her to sue.

Of course it's very possible that she ergo uses and is grateful for the fact that the hcps saved her life and that she put herself in a dangerous situation but that she will still need to sue. Purely for the fact that her life will be fucked from a financial point of view now and she will need all the money she can get.

mamadoc it's really interesting what you say about the psychological factors. I was wondering about that. I think it's not just the pregnancy people get addicted to though. I think some parents need to feel loved and the unconditional love of a baby fulfil that. But babies grow up, so the next baby comes along to fill that role. I'm not a psychologist it's just something I observed once. Who knows really... but it's all very sad either way.

mamadoc

I really agree that pregnancy is really one of the only times that women are given special attention.

It's also an "achievement" that has a lower barrier to entry (for many women) than other achievements. This woman was 31 with 7 children - she had (1) no job (2) no qualifications (3) no aspirations (4) probably very little spare cash to travel or have any life experiences.

Without her kids, her facebook would be empty IYSWIM. Children are a way to give her life with meaning and structure and having all those kids would get her lots of attention.

Foxy I got bugger all information following any of my 3 C-section's. After my 3rd I asked about scar tissue etc and I would told it wasn't too bad

I believe there should be an overhaul in the way these cases are dealt with legally. Some sort of no fault compensation fund? So you can't sue an individual doc who has genuinely done their best in s critical situation but you can receive financial assistance.
I think breaking the need to assign blame in situations can be a good thing.

I work in clinical research and I e seen both sides of this. In situations where no blame is assigned, you can get to the root cause and put procedures in place to prevent it happening again, this improving the system. In the one company I worked for that switched to a blame based system, the number of reported incidents fell dramatically - not because there were fewer but because people were afraid to report.
It resulted in more incidents and system breakdowns.

Just some musings.

Interesting point gasman are you an Anaesthesiologist? I'm afraid I gave mine quite a bad day in my section 😁 I imagine the patient turning to you and saying 'by the way, I'm starting to feel what they're doing. Is that normal..? ARRGGH! ' is probably not what makes a good op 😜

Only 2% of cases handled by the NHS Litigation Authority goes to court. I doubt that this will be. The Trust most probably will settle.

She has bilateral below knee amputation and according to the JSP Guidelines the compensation would be around £148,000 - £218,000. Plus compensation to psychiatric injury.

Litigation involves expert witnesses, barristers etc and it would cost more to litigate

In 2013/2014 There was a £1.2 billion expenditure on Clinical negligence claim and 22% of this is the claimant's legal costs. Defence costs is 8% of spending.

There should be a fixed costs regime especially for low value claims (not this one)

She did put herself in the high risk situation and therefore some of the responsibility for the tragic outcome is hers.

Not a fair thing to say after just putting forward the possibility that specific checks may have been ordered and not carried out. If that is the case, the fault lies firmly with the hospital. If someone falls off a horse and develops a medical problem that is serious but treatable, and the hospital fails to deliver care such as not carrying out ordered tests, we do not share the blame by pointing out that the fault lies partly with the patient for getting on the horse in the first place. It doesn't work that way.

On the other hand, if the hospital didn't fail to carry out checks and this complication is likely to have occurred as a consequence of having repeated c-sections then I agree that the patient contributed to the outcome insofar as she put herself in that position, knowing what the risks were.

They will have been struggling so hard to save her life and yet there's no recognition or gratitude for that

That is their job. Competency is the baseline standard. If (big if) the hospital failed to carry out specific checks for this complication, it is entirely reasonable that she should say, not 'Thank you so much for getting me through this alive' but 'Where the hell are my legs?'. We expect competency in any profession, and the times where that doesn't happen are the occasions that the professionals in practice are quite rightly pulled up.

I do not understand why doctors expect gratitude for doing their job.