30 November 2015
Twins Died in Utero after Mother was Misdiagnosed with a Pulled Muscle
Mother of three, Nicola Jaffray and her partner David Bielicki discovered they were expecting twins in April 2015.
In July, Ms Jaffray began experiencing severe pain in her ribs and back, and attended the James Cook University Hospital, Middlesbrough, where she was assessed and diagnosed with a pulled muscle.
When the pain became more severe, the couple re-attended the hospital’s maternity unit and were again advised that Ms Jaffray had pulled a muscle. She was sent home without a scan.
The following day, she was taken back to the hospital via ambulance due to severe pain. As she was due to have an ultrasound scan that day this was performed. The scan revealed that her unborn babies were suffering from ‘Twin-to-Twin Transfusion Syndrome.’
Twin-to-Twin Transfusion Syndrome (TTTS)
Twin-to-Twin Transfusion Syndrome is a condition that affects identical twins or higher multiple gestations which share a placenta but have an individual amniotic sac.
Depending on the blood vessel formation within the placenta, too much blood can be transferred from one twin (donor) to the other (recipient). This results in one twin being anaemic and having little to no amniotic sac (donor) and the recipient receiving too much blood, which can put their heart under increased pressure and potentially result in heart failure.
TTTS occurs in 10-15 per cent of identical twin pregnancies of this kind. It can occur at any point during pregnancy from 12 weeks to full term labour and in Ms Jaffray’s case occurred at 25 weeks gestation.
Sadly, occurrence at this stage is the most serious and without treatment is usually fatal. Ms Jaffray was given two options, the first being a Caesarean section providing virtually no chance of survival for the twins, or secondly, to undergo ‘intrauterine laser ablation of placental vessels.’
Ms Jaffray opted for the second treatment option in which a laser is used to break the blood vessels in the placenta to try to correct the blood flow between the twins. Unfortunately in the UK there is a lack of specialists in this kind of invasive fetal surgery. As a result, Ms Jaffray had to be transferred to St Georges Hospital, London.
Tragically, one of the babies died that night and the other died the following day whilst Ms Jaffray was being transferred to London for the specialist treatment.
The South Tees NHS Hospitals Trust has apologised to the couple and admitted that if Ms Jaffray had undergone an ultrasound scan when she first presented with abdominal pain on 22 July 2015, signs of TTTS could have been detected and transfer to the specialist centre for laser treatment could have been arranged sooner.
The outcome of this case is of course devastating, but whilst the South Tees NHS Foundation Trust has admitted and apologised for failings, in order to succeed in a clinical negligence case, it would have to be shown, by way of expert evidence, that had the scan been performed and the diagnosis been made on Ms Jaffray’s first presentation on 22 July 2015, there would have been a 51 per cent or greater chance that the babies would have survived.
The statistics for intrauterine laser ablation of placental vessels as treatment for TTTS show that there is a 70 per cent chance that both twins will survive if treatment is prompt.
The 7th of December marks World TTTS Day - an international effort to increase awareness of this syndrome. It is hoped that increased awareness among practitioners and Trusts will help to avoid more tragic endings like this one.
The clinical negligence solicitors at Slater and Gordon Lawyers help families who have had to deal with devastating birth injuries in a sensitive and supportive manner. If your baby was injured during pregnancy or child birth due to medical negligence call us for a free consultation any time of day on freephone 0800 916 9049 or contact us online.