Elisha Woods v Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust

In assessing alleged negligent obstetric management, the court applies the standards reasonably prevailing at the time. A fetal heart trace showing persistent tachycardia and apparent decelerations requires further assessment. Retained variability does not make tachycardia reassuring where it is unsafe to attribute the rate to fetal activity. A repeat trace must be sufficiently long to establish a reliable baseline and must genuinely resolve the initial uncertainty. Where further monitoring, liquor-volume assessment and fetal-growth assessment would probably have revealed continuing abnormality, reduced liquor and growth asymmetry at term, reasonable management may require induction. A later failure to ask about fetal movements is separately assessed by reference to what the patient would probably have reported.

The claimant, a protected party, claimed damages for neurological injury allegedly caused by negligent delay in her delivery at Doncaster Royal Infirmary in September and October 1998. The trial was confined to a preliminary issue concerning breach of duty, including limited causation questions. The claimant alleged that the defendant’s staff unreasonably discharged her on 28 September after an abnormal or uninterpretable cardiotocograph, and failed on 6 October to ask about fetal movements. The defendant maintained that the repeat trace was reassuring and that earlier investigations would not have led to delivery before 11 October 1998. The central questions were whether the second trace justified discharge, what further assessment would have shown, and whether inquiry about fetal movements on 6 October would have altered management.

1. First trace. The decision to undertake repeat cardiotocographic monitoring after the first trace was reasonable and appropriate. The first trace nevertheless showed a persistent heart rate of approximately 155–170 bpm, exceeding the normal baseline, together with two apparent decelerations. Retained beat-to-beat variability did not justify assuming that the tachycardia resulted from fetal activity. The trace therefore required further information.
2. Second trace. The repeat trace did not provide sufficient reassurance to justify discharge to routine antenatal care. A minimum period of five minutes was required to establish the baseline, and the trace did not contain such a period. Nor was it safe to attribute the persistent tachycardia to fetal activity, since the active period would have been unusually prolonged. The trace should have continued until the true baseline could be established.
3. Further assessment and induction. The appropriate further investigations were a further CTG, assessment of liquor volume and assessment of fetal growth. On the balance of probabilities, these would have shown continuing abnormality, reduced liquor and growth asymmetry caused by placental dysfunction and intrauterine growth restriction. At term or near term, reasonable management required induction on or around 29 September 1998. This finding determined the claim.
4. 6 October consultation. Dr Samy should have asked about fetal movements and recorded the answer. However, the court was not satisfied that the claimant’s mother would then have reported reduced movements. This issue was therefore not independently determinative.
5. Judgment was entered for the claimant, with the parties invited to draw up the appropriate order.