A woman suffering from bleeding and who collapsed at home 2½ weeks after giving birth has failed in a High Court claim for damages against the Coombe hospital, Dublin, and the HSE.
Virginia Gimenez Perez alleged, among other matters, that the hospital failed to properly diagnose and treat the cause of her bleeding after she gave birth to her second child in October 2019.
She also alleged that the Midland Regional Hospital, Portlaoise, failed to make a timely diagnosis of what was causing her bleeding when she was brought there by ambulance in November having collapsed at home. She eventually received surgery to stop the bleeding in December.
Ms Justice Emily Egan found in favour of the HSE and the hospital in a recently published decision.
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She found that the staff involved in the care of Ms Perez in both hospitals acted in ways that ordinary competent professionals might have acted and took decisions that were open to such professionals exercising reasonable care.
Ms Perez complained that the Coombe failed to properly diagnose and treat her post-partum haemorrhage (PPH) caused by the incomplete delivery of the placenta, preventing her uterus from contracting and stemming bleeding from the uterine wall.
The condition is known as retained products of conception (RPOC) and it was common cause that the PPH suffered by Ms Perez was due to RPOC.
In the Coombe at the time of the birth, the placenta was checked by a nurse who noted that it “appears complete”.
“It is common case that it is very difficult to out-rule the possibility that a small piece of placenta is missing,” the judge noted. “It is not per se negligent to conclude that a placenta ‘appears complete’ even if this transpires not to be the case.”
Ms Perez also criticised other aspects of her care while at the Coombe, including the hospital’s response to her blood loss. However, the judge found the treatment given was “effective and reasonable” given the scenario presenting.
The care given after Ms Perez attended hospital in Portlaoise was also criticised by her and her expert witnesses, with consultant obstetrician Dr Robin Ashe saying the hospital should have performed surgery on her to remove the RPOC when she was brought there by ambulance on November 4th, 2019.
However, Ms Justice Egan found that the more conservative management decided upon by the staff was “within the band of reasonable management”.
Consultant Dr Niamh Maher, who decided on the more conservative approach after having made a differential diagnosis, was “emphatic” that surgery involved a risk of uterine perforation that could have been “catastrophic” in circumstances where the patient had given birth only two weeks earlier.
Surgery was eventually carried out on Ms Perez when she presented at the hospital on December 4th, 2019. By this time the risk of uterine perforation was reduced.
The material removed, only part of which was RPOC, had moved from the uterus to the cervix with the aid of prescribed medicines and Ms Perez was “somewhat unlucky” the procedure was required, the court was told.
Ms Perez said she was weak, fatigued and introverted for some time after the surgery, did not return to normal for nearly two years, and was prescribed antidepressants.
However, the judge found her “adjustment disorder” was caused by the stress of having to undergo surgery under general anaesthetic, something that was “virtually unavoidable”.
“Fortunately [Ms Perez] states that she is now doing really well; she has a good life and feels very happy,” the judge said, as she dismissed the case.
