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Delay in Removal of Retained Placenta and Asherman’s

Delay in Removal of Retained Placenta and Asherman’s

We were able to help a lady who suffered with delay in removal of retained placenta and Asherman’s. The Claimant gave birth to her child by way of an uncomplicated vaginal delivery at the Defendant’s Hospital. The placenta was delivered by controlled cord traction and the placenta and membranes identified as complete. This was her third child.

The Mother’s Story

The Claimant was re-admitted because of post-partum haemorrhage with a retained, adherent placenta and infected retained products of conception (RPOC). The Claimant was consented for and underwent an evacuation of the retained products of conception (ERCP). No other options were offered to her.

The Claimant signed a consent form for the ERCP. The only risk documented was of a blood transfusion. The further risks which should have been identified included bleeding, infection, injury to uterus, secondary laparoscopy/laparotomy, hysterectomy and formation of intrauterine adhesions (Asherman’s syndrome).

Following the D&C she was discharged home only to return a week later with more clots and bleeding. No scans were undertaken to ascertain if there was retained products or perforation. She was again advised to undergo a further D&C. The Claimant signed a further consent form. This set out the risks as being uterine perforation, inability to remove RPOC if adherent and risk of hysterectomy. There was no mention or discussion of the increased risk of endometrial injury, the potential development of endometrial atrophy, Asherman’s syndrome or further consequential risks of secondary infertility and/or miscarriage.

No other options, such as drug therapy by way of ergometrine, oxytocin-analogues or tranexamic acid were discussed or suggested. The Claimant was amenorrhoeic (i.e. experienced suppressed menstrual flow) for more than a year, causing her constant pain. She was referred by her GP to the Defendant and underwent a lengthy series of investigations, to include three hysteroscopies and one laparotomy to rule out endometriosis and other causes. She was then diagnosed with Asherman’s syndrome.

Claim arising from Treatment

The removal of retained placental tissue postpartum and retained products of conception (RPOC) is done by uterine curettage or hysteroscopy. Trauma to the endometrium from surgical procedures, primarily curettage, can cause intrauterine adhesions (Asherman’s syndrome) and subsequent infertility. The incidence of negligence claims relating to intrauterine adhesions is rising, justifying re-evaluation of the optimal way of handling these complications.

It is apparent that due to the lack of an accepted management protocol for cases of RPOC, it is difficult to legally defend those cases when the complication of Asherman syndrome develops. Women must be advised about the risks and what complications can arise.

Call us today

We deal with a number of Asherman’s cases and understand the difficulties in accessing appropriate treatment and care. If you have Asherman’s or want to make an Ashermans Claim then get in touch with Dr Victoria Handley today. Don’t suffer in silence. Call FREE on 0800 470 2009 or email vhandley@handleylaw.co.uk

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