Gynaecology

Camilla developed a visicovaginal fistula following a hysterectomy in 2008. PMS Expert Report concluded that her treatment was negligent. Her bladder was injured during the procedure and the doctor failed to recognise the damage. If the damage had been recognised at the time, the injury could have been repaired. As a result of the negligence, Camilla's psychological condition has deteriorated, although physically she is restored. The case settled and Camilla has been compensated.

Sally had a Total Abdominal Hysterectomy in November 2009. Three days after the operation, she developed generalised peritonitis and was returned to theatre, where a bowel perforation was identified and repaired. However, she then suffered from sepsis (blood poisoning) and had to be put in the Intensive Care Unit for several weeks, during which time she had two further operations to treat suspected intra-abdominal infection. PMS Expert Report concluded that the care was negligent. Although it is not negligent to injure the bowel during a hysterectomy, it is negligent not

Nancy had a hysterectomy in 2006. Difficulties during the operation resulted in obstruction of her left ureter. She was readmitted to hospital, and underwent two operations over the next month to repair the damage. PMS Expert Report concluded that the particular nature of Nancy's uterus meant that doing the operation vaginally rather than abdominally was very difficult. Although not negligent, most Gynaecologists would have taken the abdominal approach in this case. Furthermore, the operation itself was done negligently, with insufficient care taken to avoid damage. The case settled, and, Nancy

Dana developed postmenopausal bleeding after taking unopposed oestrogen for at least nine months. She underwent a hysteroscopy to investigate. She alleged that the problem was a prescriptive error and that she has since suffered serious side effects from the unnecessary investigation. PMS Expert Report concluded that there was a negligent error in prescribing unopposed oetrogen HRT to a women who still has a uterus. This directly caused her postmenopausal bleeding as well as depriving her of the benefits of HRT for several months. The case settled, and Dana received compensation

Pandora had a hysterectomy in May 2007 for ovarian cancer. Five weeks later, her spleen ruptured and she underwent a laparotomy and splenectomy. PMS Expert Report concluded that the splenic rupture was a rare case of non-traumantic rupture. There was no negligence involved in the hysterectomy, and the two events were probably unrelated. As a result, the case was not pursued.

Tayla underwent a Total Abdominal Hysterectomy (TAH) and Right Ovarian Cystectomy in December 2009. She was readmitted with severe pain a week after the operation, but an ultrasound scan was not performed. The pain continued for several months until she was then admitted as an emergency in March. Investigations revealed a pelvic condition and she was treated with intravenous antibiotics before being discharged. An ultrasound done in May showed a persistent pelvic condition, and she was put on a waiting list for elective surgery to deal with it. However in

Harriet underwent a laparotomy and removal of her left ovary in 2009. She was readmitted 11 days later with severe abdominal pain. The wound fell apart and released a large amount of green pus. 14 days after this she underwent a second laparotomy that identified damage to the bowel caused by the previous operation. Harriet was then in intensive care for a lengthy period, and continues to have problems leading her daily life. PMS Expert Report concluded that the failure to identify perforation to the bowel in the first operation

Linda underwent a laparoscopic right ovarian cystectomy and dye test in July 2010. She was readmitted twice with lower abdominal pain and vomiting. A right ureteric injury was eventually diagnosed in August 2010. Attempts to manage this failed, and a month later she underwent a laparotomy to re-implant her right ureter. She made a good recovery, although continues to have an unsightly lower midline incision, about 15cm long. PMS Expert Report made several findings on the case. Firstly, the decision to perform a laparoscopy was itself premature. Secondly, the operation

Jill underwent laparotomy and left ovary removal in April 2011. The procedure was very difficult due to adhesions and complicated by bleeding on the right pelvic side wall. Jill was then transferred to the intensive care unit and returned to theatre the following day, where is was discovered that she was still bleeding internally. The post-operative period involved staying at total of 3 hospitals over 11 weeks. To this day, Jill continues to have problems including right foot drop and urinal and faecal incontinence. PMS Expert Report considered the haemorrhage

Nina had a laparotomy for a left paraovarian cyst in 2002. She developed an infected haematoma in the wound, which took a long time to heal up and left an unsightly scar. She alleged negligence in performing the operation. PMS Expert Report concluded that the wound infection was a recognised complication of surgery, and so the case was dismissed.

Christabel was 22 when she underwent a laparoscopy and hysteroscopy in 2010. Two days later she was readmitted with severe pain, and a further laparoscopy and cystoscopy was performed. This revealed a perforation in the anterior wall of the bladder. Subsequently she suffered a wound infection, and continued to have a suprapubic wound for 2-3 months afterwards. PMS Expert Report concluded that bladder perforation is a recognised complication of laparoscopy, and that although the failure to identify it could be seen as negligent in some cases, in this case the

Suspected damage to the ureter during laparoscopy Delia had a laparoscopic left ovarian cystectomy and dye test in May 2010. She was readmitted twice with lower abdominal pain and vomiting, and in June a left ureteric injury was diagnosed. Attempts to pass a stent down the bladder failed, and in July she underwent a laparotomy with re-implantation of the right ureter. PMS Expert Report identified the treatment in June as negligent, as the doctor damaged the ureter, and failed to recognise the injury. The subsequent pain, which lasted for 3 weeks,

Paula had a laparoscopic left oophorectomy in 2003. The procedure was complicated by bleeding from the left port site, and she returned to theatre the next day. She alleged that the procedure was negligently performed. PMS Expert Report noted that the port site bleeding is a recognised complication of laparoscopy. Although critical of the nursing staff for failing to notify a Gynaecologist 12 hours earlier, PMS concluded that Paula would have had to go back to theatre either way, and her long term prognosis was not affected. The case was

At the age of 25, Marianne was referred for investigation of primary subfertility and a persistent endometrial polyp was diagnosed in October 2006. In May 2007 she underwent a hysteroscopic polypectomy, whereupon a uterine perforation was diagnosed. Severe abdominal pain provoked a laparotomy 5 days later, where a perforation of the rectum was identified, associated with faecal peritonis. After 9 days in the Intensive Care Unit and 13 further in hospital, Marianne was eventually discharged. PMS Expert Report concluded that the hysteroscopic polypectomy was performed negligently, probably resulting in perforation

Crystal was 16 when she underwent a medical termination of pregnancy at 9 weeks. She subsequently went to A&E on several occasions over the next fortnight, until eventually she underwent an evacuation of retained products of conception. Crystal alleged that the retained products should have been detected sooner, avoiding pain and distress for 14 days. PMS Expert Report concluded that Crystals symptoms were entirely normal following a termination, and that the conservative treatment she received was appropriate. Furthermore, there was no evidence that the products of conception were actually found

Carly had an Mirena Intra-Uterine System (IUD) fitted in November 2004. Three months later she developed severe lower abdominal pain and was diagnosed as having an ectopic pregnancy. Her left fallopian tube was removed. She alleged that the Drug Company who makes Mirena should pay her compensation. However, PMS Expert Report concluded that there was no negligence involved. Ectopic pregnancy is a small risk of the IUD, occurring in 1 in 5000 women who use it for a year. This is unfortunate but unavoidable. The case was dismissed.

Sybil had an Implanon inserted in February 2004. However, in April 2005 she became pregnant, and the baby was born in December. An ultrasound scan showed no evidence of an Implanon device in Sybil's arm, and a blood test showed no trace of the hormone Etonegestrel, which should be present in the Implanon. PMS Expert Report concluded that the Implanon Device was almost certainly inserted incorrectly, and that the doctor failed to palpate the arm to check that the insertion had been successful. This resulted in the unplanned pregnancy. The

Ruby planned to have a total abdominal hysterectomy in 2009, but because of adhesions, only a myomectomy and bilateral salpingo oophorectomy were performed. Ruby continued to get regular periods and severe pelvic pain. An ovarian remnant was identified. In 2010 she underwent a hysterectomy and the ovarian remnant was removed. She alleged that there was a breach of duty in failing to remove both ovaries completely, and that the doctor performing the initial hysterectomy should have sought the help of a more experienced consultant. PMS Expert Report concluded that the

Winnie was 41 in 2007 when she had a hysterectomy. She subsequently developed chronic post-surgical pain and alleges that she was not warned of this complication beforehand. PMS was asked to assess the case on behalf of the hospital in order to see if it was worth defending. PMS Expert Report concluded that the claim is worth defending, as it is not routine practice to warn patients of the risk of chronic pain, and indeed, it is unlikely that Winnie would not have consented to the hysterectomy had she been

Gillian was 16 when she presented with lower abdominal pain in 2001. She was admitted to hospital and underwent a scan which showed a full bladder. The pain subsided and she was discharged. She was readmitted two weeks later and an ovarian cyst was diagnosed. She then underwent laparotomy with left salpingo-oophorectomy. She alleged that the cyst should have been diagnosed earlier, and that this would have avoided subsequent pain and extensive surgery. PMS Expert Report concurred, noting that the failure to diagnose a very large tubal cyst in the

Sarah had a laparotomy in 2001, during which both ovaries were removed. She presented with a history of left-sided abdominal pain in 2004, resulting in another laparotomy in 2005 at which an ovarian cyst was drained and partially removed. Subsequently her left ureter became obstructed and needed to be stented. Sarah alleged that both ovaries should have been removed in the operation in 2001, and that it was negligent to leave ovarian tissue behind. She also claimed that this made her unable to work. PMS Expert Report concluded that a

Claire underwent outpatient hysteroscopy in 2006 for investigation of recurrent miscarriage. She presented seven weeks later with persistent vaginal discharge, and was found to be 16 weeks pregnant with ruptured membranes. Claire alleged that it was negligent to perform the hysteroscopy without first conducting a pregnancy test. PMS Expert Report concluded that although it was negligent not to perform a pregnancy test first, this made no difference to the outcome of the pregnancy. The fetus had a lethal cardiac abnormality and would not have survived. The case was dismissed.

In 2002, Tracey had an Implanon device inserted in her left arm. In 2004 she requested removal of the device, as she wished to get pregnant. The doctor failed to locate the device. She was referred to a Consultant Orthopaedic Surgeon, who was able to removed the implant through a deep surgical incision. PMS Expert Report concluded that the Implanon device was negligently inserted in the first place, with the doctor putting it much too deep. This resulted in the subsequent migration of the device, making it extremely difficult to

Martha was 36 when she was referred to hospital, complaining of painful periods. She was found to have chronic pelvic inflammatory disease, and was treated by a Laparoscopic Bilateral Salgingectomy and Microwave Endometrial Ablation (MEA). She claims not to have been informed that the MEA would destroy the lining of her uterus, making pregnancy impossible. PMS Expert Report concluded that this treatment was negligent. MEA is usually only offered to women who have finished having their family. The suggestion of MEA seems to have been raised at the last minute

Juliet was 42 when her uterus was perforated by a Mirena IUS inserted by her GP. She was referred to hospital the next day, and a laparoscopy was performed, revealing that the Mirena had passed through the posterior wall of the uterus. It was alleged that both the insertion of the Mirena and prior consultation were negligent. PMS Expert Report concluded that the GP's insertion of the Mirena was erroneous, but that this is a recognised complication of insertion of an interuterine device. Failure to inform Juliet of this complication

Cosette alleged negligence in performance of a tubal ligation procedure in 1996. Six years later after the procedure she developed an abscess in the wound which was persistent. Eventually a sterilisation clip was found in the wound, and the problem resolved. PMS Expert Report concluded that although Cosette suffered from a rare complication of tubal ligation, there was no evidence of negligence. This clips often become detached from the fallopian tube and migrate, and Cosette's case was an unfortunate consequence of this. The case was dismissed.

Cheryl was 25 when she presented with a missed miscarriage in her third pregnancy. She underwent an Evacuation of Retained Products of Conception in 2008. Following this she developed pelvic pain, and passed a swab 5 days later. She alleged that this was a breach of duty by the doctor who did the operation. PMS Expert Report agreed, as leaving a swab in the vagina was clearly negligent. It did not seem that there were any long term consequences. The case settled, and Cheryl was compensated for her five days

Arabella was diagnosed with Stage 1b cervical cancer at the age of 40. She underwent a radical hysterectomy and was subsequently unable to walk due to a bilateral femoral neuropathy. She alleged that this was due to incorrect placement of the abdominal wall retractors, causing pressure and a traction injury to the femoral nerves. PMS Expert Report concluded that there was no negligence in her treatment. Although it is possible that the injury was caused by traction from the retractor blades, this is not a recognised problem of the procedure.

Thea was found to have a large ovarian cyst and underwent laparotomy, hysterectomy and bilateral salpingo oophrorectomy in 2011. She developed an incisional hernia which was repaired in 2012. She then developed generalised peritonitis and underwent laparotomy and small bowel resection a few days later. This operation resulted in a wound infection that took four months to heal. PMS Expert Report concluded that a small bowel injury occurred at the time of incisional hernia repair. The subsequent problems were a direct cause of this negligent practice, which required a further

Winnifred was 26 when she underwent a laparotomy and right salpingectomy for ectopic pregnancy. She alleged that there was a delay in making the diagnoses and that she had a poor standard of care. PMS Expert Report concluded that although the ectopic pregnancy could have been diagnosed earlier, many junior doctors prefer to wait for an ultrasound report to make the diagnosis for sure. PMS has no criticisms of Winnifred's standard of care. The case was dismissed.

Celia underwent microwave endometrial ablation (MEA) for treatment of heavy periods. She presented two days after the operation with peritonitis due to perforation of the small bowel. She was taken back to theatre for a laparoscopy followed by a laparotomy with a defunctioning loop ileostomy. She was readmitted to reverse the ileostomy 6 months later, and alleged that the MEA was performed negligently, causing deep damage of the small bowel. PMS Expert Report concluded that bowel perforation is an unfortunate but recognised complication of MEA. The case was not pursued

Tatiana had 3 children and was 30 years old when she underwent an Adiana hysteroscopic sterilisation in November 2011. Hysterosalginogram was carried out in March 2011 and she was told that the fallopian tubes were occluded. However, she discovered that she was pregnant in June 2012 so underwent termination of pregnancy with laparoscopic clip sterilisation. Further problems due to retained products of contraception were treated with medication. Tatiana alleged that the hysteroscopic sterilisation was performed in a negligent manner, leaving to further complications and the termination. PMS Expert Report concluded

Pat was involved in a road traffic accident and miscarried 6 weeks later. PMS was asked to comment on whether the RTA caused the miscarriage. PMS noted that given that the miscarriage occurred 6 weeks after the accident, there did not seem to be either correlation or causation. Furthermore, at the time of the accident, the fetus was only at 8 days gestation - too small to be disturbed by the accident. The case was dropped.

Zoe presented on two occasions with right-sided abdominal pain and bleeding in early pregnancy. On the second time, she had a scan which suggested ectopic pregnancy. On the same day, her doctor did a laparoscopy and removed the left fallopian tube, as well as performing a right salpingostomy. This was despite the fact that her scan showed that that the left tube was normal whilst the right contained the pregnancy. Zoe alleged that her doctor was negligent in removing the left tube and, as a result of the right tube

Louise, was found to have a large cyst on her right ovary. She underwent a laparoscopic procedure to remove this and the specimen was extracted through the RIF ports, which was extended because of the size of the specimen. This lady was admitted five days later with small bowel obstruction and on investigation, she was found to have a right port site hernia. The PMS report stated that the rectus sheath at the RIF port had not been properly closed following removal of the specimen, leaving a large defect into which

Toni requested that a Mirena coil be fitted for contraception, but the insertion procedure was very uncomfortable and she complained of severe pelvic pain for several weeks. Her GP did not recognise the problem and there was a considerable delay in starting the investigations.  An ultrasound scan showed that the coil was not located in the uterus, but there was further delay in performing an x-ray, which showed that it was in the abdominal cavity. She required a laparoscopic procedure to find and remove the device. The PMS report noted that the claimant

"Just a quick e-mail to say thank you for all your input in this case. It was invaluable and very important in achieving the settlement. My suspicion is that the Defendant made the offer of settlement knowing that it was in difficulty in particular in relation to the surgical issues within the claim (i.e. your remit). In any event, I’d personally like to thank you once again for all your dedicated input and assistance." Barrister for a recently settled obstetrics case