Part 3: RPOC - Retained Products of Conception causing post-natal infection

In this series of articles, I am looking at birth related injuries affecting the mother as opposed to the baby.  The vast majority of mothers give birth to healthy babies without any harm to the mother. On some occasions however, the outcome for the mother is not so good with injury occurring that may lead to short, medium or even long term consequence. In some of these cases, the maternal injury or poor outcome was caused by neglect and it is to that neglect – and only in cases of clearly proven neglect, that the law addresses the issue of compensation.

 

Earlier articles in the series looked at episeal tears and perforations to bowel or bladder and how these occurrences can give rise to legal liability. Now I want to address Retained Products of Conception (RPOC). This term refers to placental and/or fetal tissue that remains in the uterus after a spontaneous pregnancy loss (miscarriage), planned pregnancy termination, or preterm/term delivery. As with all aspects of obstetrics and gynaecology, this is a complex area of medicine where lawyers rely on expert opinions from doctors and so what is offered here is not medical advice but a simple overview of the medico-legal issues that can arise where the management of this issue falls below an acceptable level of care and the woman suffers ill-health and harm.

 

RPOC in simple terms is where in the case of a birth, miscarriage or abortion, some tissue from the placenta or foetus is left inside the uterus or within the fallopian tube in the case of an ectopic pregnancy. In any of these situations, the tissue in question will decay and cause infection which in turn, if not addressed, will lead to varying symptoms of illness in the woman – typically fever, uterine bleeding, pelvic tenderness and pain. Such an infection can, if it goes untreated, cause damage to adjoining tissues and spread beyond. It can then lead to systemic illness such as sepsis or localized harm potentially threatening or damaging fertility or causing ongoing pelvic pain.  It is a serious matter and for that reason doctors and particularly obstetricians and gynaecologists are trained to avoid the occurrence of RPOC and be alert to the signs and potential for such resulting infections.

 

The cases I have worked on in this area have mostly related to two categories rather simply described as:

 

A failure to identify RPOC from an ectopic pregnancy which occurs when the egg is fertilized and develops within a fallopian tube. Such a pregnancy is not viable and can cause damage to the tube itself which may or may not be reparable by the surgeon. The consequences of the loss of a fallopian tube which may then arise can be of moderate significance or of major significance depending on whether the woman has a second functioning fallopian tube or not and will - in terms of degree of harm - be influenced by whether or not she has an intention to have further children. These issues will vary from case to case.

 

2.   Failure to deliver the placenta in full. The third stage of labour is marked by the delivery of the placenta. The placenta is not always delivered intact and this can be a affected by the health of the placenta itself and/or the mode of delivery. The complication is less likely to arise in deliveries by caesarian section. In all cases however the placenta will be examined following delivery to ensure the entire placenta has been removed, a process that in some cases can be akin to rebuilding a jigsaw. Where an incomplete placenta is noted, the missing part or parts are the RPOC. The body can resolve this problem itself in many but not in all cases and so the woman ought to be informed and closely monitored to ensure that the RPOC are not retained for a sufficient period to allow infection to occur.

 

In either case, ultrasound is a valuable diagnostic tool to monitor the situation and either surgery on the fallopian tube or by means of a procedure to clean he uterus known as a Dilation and Curettage (D&C).

 

There are long established and regularly reviewed procedures to monitor and treat these potentially harmful conditions and these are published by the relevant medical standards organisations for obstetricians and gynaecologists and between Ireland and the UK, these practices are very similar. Because of this similarity, we are able to seek independent expert advice on queries we receive from doctors in the UK.

 

As an aside here, many people comment on the fact that we always work with UK doctors in our cases and suggest that this is evidence of an ‘old boys club’ among Irish doctors. I do not subscribe to this view. I think it is important that we maintain a harmonious medical profession in Ireland, one where doctors are not giving evidence against one another in court but can act together as a relatively small and collaborative unit for the advantage of patients throughout what is a very small county. It makes sense therefore to ask ‘outsiders’ to comment on the quality of care when queries arise. We are after all dealing with mistakes, not deliberate acts and mistakes happen to us all in our work, even when we try to be careful.

 

Not all RPOC related infections will be an occasion of negligence but to ask questions or seek an independent opinion on whether such an infection, often leading to very serious illness and even lifelong harm should have been avoided is justified.

 

In the RPOC cases that our firm has worked on, we have seen a high incidence of criticism from the independent medical reviewer which tells me that our clients have a very good sense of when their care has been deficient. In other words, when they thought they had been let down by the hospital, they were nearly always correct.

 

Cian O’Carroll Solicitors, A Medical Negligence & Personal Injury Law Firm. FREEPHONE 1-800 60 70 80 | WWW.TIPPLAW.COM

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