What is Gynaecology?

Gynaecology means the ‘science of women’. This relates to the health of reproductive organs. Women need highly specialised medical care for their gynaecology issues. This is a large area of medical practice. Equally, gynaecology is a large contributor to medical negligence claims.

Various problems can occur during treatments, such as perforation of the womb. Perforation can occur during insertion of a coil, or during a pregnancy termination procedure. Investigative procedures, called ‘hysteroscopy’, can also end up with injuries. Failures to measure the length of the vagina and womb can lead to instruments being inserted too deeply. Routine hysteroscopy procedures can also be conducted by those less experienced in their field.

Perforations can be repaired IF recognised at the time of injury. Perforations can lead to infertility issues. This is because delays in recognising the injury can make the problem worse. Delays can lead to infection and sepsis. Sepsis can lead to the loss of the womb (‘hysterectomy’). Even if hysterectomy does not result, women can be left with shrunken (‘atrophied’) wombs after serious infection cases. This can mean that they can no longer carry a baby to term, or deliver a baby safely. It can even mean that a lady cannot opt for egg retrieval to allow for surrogacy as egg retrieval becomes too dangerous for the lady wishing to have a baby.

Issues of consent are important. Full advice should be given about the removal of pelvic organs. A properly signed consent should be taken for a surgical procedure. During a hysterectomy procedure to remove the womb, it would be wrong to also remove the ovaries unless a patient has been advised about this and has given written consent.

Why does Sterilisation go wrong?

Sterilisations are commonly successful, but these procedures tend to be left to more junior doctors. It is not uncommon for a junior surgeon to mistake surrounding tissues for the fallopian tube. This can lead to the sterilisation clip being applied to a ligament. Sterilisation clips should be applied to the fallopian tube. Is this happens, it will lead to an unplanned pregnancy, usually within 12 months of the surgery.

If pregnancy occurs later than a 12-18 month period after sterilisation, then this will usually be down to bad luck, rather than a surgical error. The fallopian tube can regenerate itself by forming a tube around the clip and finding its way back to the ovary (‘tubal lumen regeneration’). However, this does take time so tends to happen after uite a few months.q

What can I claim when sterilisation goes wrong?

If treatment goes wrong in sterilisation, there are various claims that can be made:

• Wrongful conception. An action in contract may arise if the sterilisation procedure was performed outside the NHS in the private sector.

• Negligence. A breach of duty arises when an operation is not carried out in accordance with the practice accepted as proper by a reasonable body of gynaecologists. This is also referred to as the Bolam test.

• Negligence also occurs when there is failure to give full advice in pre-operative counselling.

• Wrongful birth. This is where a mother would have opted for lawful termination of pregnancy had she been properly advised about risks of pregnancy. It also covers situations where properly advised, she would have avoided getting pregnant at all.

Women are entitled to recover compensation called ‘general damages’ for pain and suffering during pregnancy and delivery, and loss of earnings during pregnancy. However, a judgement in the year 2000 held that the costs of bringing up a healthy child can no longer be claimed (as per, McFarlane v Tayside Health Board). This includes excluding associated loss of earnings.