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Twin and multiple pregnancies account for 1 in 65 births in the UK. Mothers and babies are at higher risk where the pregnancy involves more than one baby and need specialist maternity care. Having twins increases the risk of many of the complications of pregnancy. These include the development of potentially harmful conditions, such as intrauterine growth restriction (IUGR), pre-eclampsia, and gestational (pregnancy-related) diabetes. Twin pregnancies also have complications of their own, such as twin-to-twin transfusion syndrome (TTTS).
Twin pregnancies must be treated as high risk throughout the mother’s antenatal care, labour and delivery, and in the neonatal (newborn) period immediately after birth. Regular scanning and monitoring throughout pregnancy, and careful planning, monitoring and management of the delivery are essential to ensure a safe outcome for mother and babies.
Boyes Turner’s birth injury specialists are experienced in recovering compensation for twins and their mothers who have been injured by negligent maternity care.
Our clients benefit from:
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We tend to think of twins as identical or non-identical. However, during pregnancy, twins are classified by whether the babies share the placenta and its inner and outer membranes. The type of twins determines the risk and the level of specialist care that the mother should receive throughout her pregnancy, labour and delivery.
There are three types of twins:
The number of antenatal appointments, tests and scans, and the level of care that the mother should receive depends on the type of twins she is carrying. Parents can find out which type of twins they have at the antenatal ultrasound scan appointment between 11 to 14 weeks of pregnancy. This appointment also confirms the date that their babies are due and provides Down syndrome screening.
Having twins, triplets or other multiples increases the risk of developing complications of pregnancy. These complications include:
The most common complication of twin and multiple pregnancies is low birthweight (below 5.5lb) and premature (early) birth. Babies who are born before 37 weeks of pregnancy are usually described as premature. 60% of all twins and 80% of all triplets are born prematurely.
Prematurity increases the risk of serious health problems for newborn babies whose organs may not have fully developed at the time of birth. They need help with breathing, feeding, controlling their body temperature or fighting infection. They are also at risk of injury from other serious conditions which need early diagnosis and treatment, such as blindness from retinopathy of prematurity (ROP) in babies whose retina has not fully developed before birth. For this reason, premature babies usually need specialist care in a neonatal intensive care unit (NICU or SCBU) after birth.
Anaemia in pregnancy may be caused by lack of iron. Treatments for anaemia include making changes to the mother’s diet, and taking supplements, such as iron tablets and folic acid. Untreated anaemia increases the risk of life-threatening injury to the mother and unborn baby from harmful conditions, such as IUGR (intra-uterine growth restriction), infection, heart failure and bleeding.
Intrauterine growth restriction (IUGR)
Babies with IUGR fail to grow at the expected rate for their gestational age (number of weeks of pregnancy). It is not unusual for twins to be slightly smaller than single babies, but where one or both twins are not growing properly their lives may be at risk if the growth restriction is caused by problems with the umbilical cord or the placenta. The twins’ growth should be checked regularly by ultrasound scans, and charted during pregnancy, so that any signs of IUGR are detected early and, if needed, the twins can be delivered prematurely.
High blood pressure (hypertension), pre-eclampsia and HELLP syndrome
Women who are expecting twins have more than double the risk of developing high blood pressure (hypertension) when compared to women with ‘singleton’ pregnancies. Hypertension in twin pregnancy may also develop earlier and be more severe than in a pregnancy with one baby. Hypertension in pregnancy increases the risk of detachment of the placenta (placental abruption).
High blood pressure can also be a sign of other serious conditions.
High blood pressure and protein in the mother’s urine (proteinuria) during pregnancy may indicate that the woman is developing pre-eclampsia. Other symptoms of this dangerous condition include severe headaches, swelling (oedema) of the ankles, face or hands, visual disturbance and abdominal pain. If a pregnant woman shows signs of pre-eclampsia she must be monitored carefully and treated to avoid serious injury to herself and her baby/babies. Treatment for pre-eclampsia usually involves admission to hospital, bedrest, medication and careful monitoring, to bring the mother’s blood pressure down to safe levels. If the mother’s blood pressure remains above safe levels, it may be necessary to deliver the baby/babies prematurely to avoid serious injury.
HELLP syndrome is a very dangerous condition which develops in the later stages of pregnancy and needs urgent treatment as it is potentially life-threatening for both mother and baby/babies. It is similar to pre-eclampsia but is often misdiagnosed, causing delays in vital treatment. HELLP is an acronym taken from the key features of the condition, which include Haemolysis (breakdown of red blood cells), ELevated liver enzymes and Low Platelet count (affecting blood clotting). Treatment for HELLP usually involves delivery of the baby/babies, and the mother receiving a blood transfusion. If HELLP is left untreated, the mother may become critically ill or die from liver rupture or stroke. The unborn babies may be stillborn or suffer brain injury from placental failure or abruption.
When a woman develops diabetes in pregnancy it is known as gestational diabetes. This type of diabetes can often be managed by diet and exercise. If the condition is severe, then the mother may need tablets or insulin injections to keep her blood sugar within safe levels. Gestational diabetes must be diagnosed, monitored and kept under control. Uncontrolled gestational diabetes increases the risk of developing many of the complications of pregnancy, such as high blood pressure, pre-eclampsia, shoulder dystocia, stillbirth, prematurity. It can also cause problems for the newborn baby, such as breathing (respiratory) difficulties, neonatal hypoglycaemia and jaundice.
Twin-to-twin transfusion syndrome (TTTS)
Twin-to-twin-transfusion syndrome or TTTS is a rare but serious complication of twin pregnancy, triplets and other multiple births. TTTS affects 10-15% of identical twins who share a placenta (monochorionic). MCDA (monochorionic diamniotic) twins have the highest risk of developing TTTS, but MCMA (monochorionic monoamniotic) twins can also be affected.
Twin-to-twin-transfusion syndrome occurs when abnormalities in the blood vessels of the placenta allow more blood to flow to one twin than the other. The twin who receives less blood (the ‘donor twin’) is left undernourished and anaemic. The twin who receives too much blood (the ‘recipient twin’) may suffer heart failure from their cardiovascular system becoming overloaded, and complications from too much amniotic fluid.
If a woman who is pregnant with MCDA or MCMA twins experiences any of the following ‘red flag’ warning symptoms for TTTS, she should seek medical help straight away:
• sudden swelling or distension of the abdomen;
• abdominal pain;
• sudden breathlessness;
• inability to lie on her back;
• reduced fetal movements.
When TTTS is suspected in a twin pregnancy, frequent ultrasound scanning must take place to monitor the babies’ growth and health. The mother may need to be referred urgently to a fetal medicine centre for specialist treatment. Any delays in diagnosis of TTTS or referral to a specialist fetal medicine centre for treatment can result in death or brain injury to the unborn babies.
Breech presentation and delivery of twins
When a baby is positioned in their mother’s uterus (womb) with their bottom or feet down (instead of head down) in the last weeks of pregnancy this is known as a breech presentation. This can happen in any pregnancy, but it is common in twin pregnancies for one twin to be in the breech position.
In twin or multiple pregnancies, it is important that the method and timing of the babies’ delivery is carefully planned in advance with the mother and an experienced obstetrician. Twin births should be managed in hospital under the care of a multi-disciplinary maternity team including midwives, an obstetrician and paediatricians. Throughout labour and delivery the unborn twins must be monitored carefully with electronic fetal heart monitoring, such as CTG or fetal scalp electrode.
Twin births are often recommended to take place by caesarean section, especially if the first twin is in the breech position or the second twin is in transverse position. However, once labour has started, it may be safer for the babies to be delivered vaginally. Vaginal breech deliveries of twins need careful management by obstetricians who are skilled in handling the complications of multiple births and vaginal breech delivery. Severe brain injury to babies (and birth injury compensation claims) commonly arise from maternity emergencies in which inexperienced or unskilled junior obstetricians are left to manage unplanned vaginal breech deliveries.
Boyes Turner’s birth injury specialists investigate the circumstances of each client’s injury, and the standard of care they received, to identify where mistakes have caused or contributed to their injury or disability.
Examples of mistakes or negligent care which commonly lead to twin pregnancy compensation claims include:
Our experienced birth injury solicitors investigate the cause and the nature of each client’s injury carefully, to ensure that our client receives their full entitlement to compensation. This includes ensuring that the long-term consequences of their injury, such as future developmental or increasing disability, are understood and taken into account when assessing their future needs and the value of the claim.
Injuries which often lead to twin pregnancy negligence compensation claims include:
£2,225,000 settlement for a boy who suffered a severe brain injury from twin-to-twin transfusion syndrome (TTTS) after delays in referring his mother to a fetal medicine centre for specialist care during pregnancy.
£24 million equivalent settlement for a second twin whose brain injury and cerebral palsy were caused by hyperstimulation of her mother’s uterus during a negligently managed induction of labour.
£2.9 million settlement for a second twin whose brain was injured leading to HIE and cerebral palsy when his oxygen supply was cut off by the umbilical cord around his neck during a negligently delayed delivery.
Compensation settlement for the family of a second twin whose brain was injured during delays caused by a fetal monitoring mix-up in labour.
Judgment for our client in a claim for a premature twin who suffered a brain injury after negligent treatment of necrotising enterocolitis and negligent ventilation causing hypocarbia.
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Medical negligence is when a medical professional, such as a doctor, midwife, or nurse, or other healthcare practitioner is negligent if they act in a way that falls below any acceptable standard of care.
If someone is injured as a result of medical negligence, they are entitled to compensation for any injury that was caused and for the financial consequences of that injury.
Medical negligence claims that involve severe injury and disability should always be handled by specialist medical negligence solicitors. It takes experience and skill to successfully prove that medical negligence has caused a patient’s injuries, and to secure the highest levels of compensation.
Anyone who has suffered serious injury or disability as a result of negligent NHS or private medical care can make a medical negligence claim for compensation. Special rules apply to children, adults with mental incapacity, and claims arising from a fatal injury/someone’s death.
Children and teenagers under the age of 18, or anyone with mental incapacity, must make their claim via a ‘litigation friend’. This is usually a parent or guardian in the case of a child, or a partner or other adult family member in the case of an adult with mental incapacity. The solicitor handling the claim takes instructions and works closely with the litigation friend whilst ensuring that decisions are made in the best interests of the child or mentally incapable adult who is making the claim. You can find out more about making a claim for a child.
Some important decisions, such as agreements to settle a child or mentally incapable adult’s claim, must be approved by the court. Arrangements must also be made to safeguard the child or mentally incapable adult’s compensation, whether from an interim payment, lump sum settlement or agreed future payments. Depending on the claimant’s circumstances, this may be done by paying the money into a Court Funds Office account until the child is 18, by appointing a Court of Protection deputy or setting up a personal injury trust. You can find out more about Court of Protection deputyship and personal injury trusts.
If the claim is for bereaved family members and dependants after medical negligence caused someone’s death, the claim must be made by the deceased’s personal representative (executor or administrator of their estate) on behalf of all who are entitled to compensation as a result of the death. You can find out more about making a fatal injury medical negligence claim here.
The NHS has a responsibility to provide its patients with a safe and acceptable level of care. If a patient is seriously injured or their condition is made significantly worse as a result of negligent NHS care, the patient may be entitled to claim compensation.
Compensation can help meet the costs of care, therapies, equipment and home adaptations that are needed when an NHS mistake causes injury or disability that permanently affects the patient’s life.
We are experts at helping clients receive the compensation they deserve from the NHS. We understand the concerns that patients and their families sometimes have about claiming against the NHS. You can read our answers to many of the most common questions on our NHS claims page or speak to one of our solicitors about your own claim by contacting us.
Whilst we cannot guarantee that any particular claim will settle out of court, we take great care in investigating and preparing each claim that we take on. Our clients’ claims usually settle successfully without the need for a contested trial.
Occasionally, cases can only be concluded by a formal court hearing, such as where:
Where our client’s claim is complicated by any of the above, we may advise our client that for the case to proceed, it must go to a court hearing. Our caring and highly experienced medical negligence solicitors and barristers ensure that our clients are always kept informed and supported.
Even in non-contested cases, there will be occasions when the case is brought for shorter hearings before the court, such as after a settlement for a child or brain injured adult without mental capacity takes place. In these cases, the lawyers for both sides present the agreed settlement to the court for the judge’s approval.
Each claimant’s compensation is calculated in accordance with mandatory rules based on their individual circumstances.
Compensation for medical negligence should put the injured person back in the position that they would have been in if the negligence hadn’t happened, in so far as money can.
In a medical negligence claim, the amount of compensation depends on:
Compensation for medical negligence usually includes a sum for the injury, and sums to compensate for financial losses and the cost of meeting the needs that arise from the disability.
Our medical negligence solicitors ensure clients receive their compensation in the way that is best suited to meet their needs.
Depending on our clients’ injuries, individual circumstances and needs, we can recover compensation to pay for:
Where medical negligence caused someone’s death, compensation may be claimed by the deceased’s dependants and on behalf of the deceased’s estate. Compensation in a fatal injury medical negligence claim can be paid for:
There are three ways to fund a medical negligence claim, legal aid, no win no fee, and legal expense insurance.
A medical examination is usually needed to assess our client’s injury. Where our client has suffered multiple injuries or both physical and psychological injuries, they may need to be examined by specialists in each area. This is important to make sure that our client’s injuries are fully assessed and understood, so that they can be properly compensated.
If a medical examination is needed, we instruct the specialist and make the arrangements. We ensure that they have access to our client’s medical records and are aware of the background to the claim. The hospital or doctor against whom the claim is being made may also ask for our client to be examined by their medical expert.
The law states that, in most cases, someone who has been injured as a result of medical negligence has three years from the date of the negligence which caused the injury to issue court proceedings. If they fail to issue court proceedings within that time, their claim will be statute barred, meaning that they lose their right to bring a claim.
There are the following exceptions to the three-year rule:
Regardless of your time limit, we recommend that you contact our medical negligence solicitors as soon as you can, even if at that stage you are only considering whether to make a claim.
By contacting us early, it avoids later problems with deadlines and allows us to advise you on how to collect and preserve essential evidence. This enables us to ensure you have the best chance of securing your entitlement to full compensation for your claim.
If a baby, child, or teenager under the age of 18 makes a claim for compensation for injuries caused by medical negligence, their claim is made on their behalf by a ‘litigation friend’. This is usually a parent or guardian.
As the child’s solicitor, we have a responsibility to make sure that all decisions relating to the claim are made in the best interests of the child. To do this, we work very closely with the child’s family. Some important decisions, such as settlement agreements or the amount of money that is allocated to a child in a claim involving more than one claimant, must be approved by the court.
We are specialists in helping families obtain full compensation for children who have been very severely injured, leaving them with permanent disability and lifelong specialist needs. Our expert children’s claims service includes a dedicated Court of Protection team who help our clients protect, budget and access their compensation via deputyship and trusts, and an SEN team to ensure that their special educational needs are met. Find out more about how we help families, children, and teenagers with children’s claims.
If you think that you or a family member have received negligent medical treatment or have experienced malpractice, we recommend that you speak to one of our friendly, experienced clinical negligence claim solicitors as soon as possible.
You can contact us by telephone or by email. Your enquiry will be handled confidentially and preliminary advice in relation to pursuing a claim will be given free of charge.
Our medical negligence solicitors will ask you to tell us briefly what has happened, advise you about the limitation deadlines (time limits) which apply to your claim and whether we are able to help you investigate your claim.
Once our initial investigations have taken place, we will notify the defendant (hospital or doctor) of your intention to pursue a claim and invite them to respond, giving them an opportunity to admit liability, before court proceedings are issued.
If liability is admitted, we will enter judgment and apply for an interim payment as soon as possible to meet any urgent needs that you may have as a result of the negligently caused injury.
If liability is disputed, we will discuss with you the further steps that we need to take to progress your claim.
Our extensive guide on making a medical negligence claim explains the whole process, if you require any further information.
The duration of a medical negligence claim depends on the individual circumstances of the client’s case. The claim is likely to take less time to conclude where:
Circumstances which make the claim more complex and therefore take longer to resolve include:
Our medical negligence solicitors work hard to secure early admissions of liability and substantial interim payments so that we can begin to alleviate financial hardship and provide essential care, respite, specialist equipment, therapies and home adaptations long before the claim has settled. With liability judgments secured and interim funds in place, the individual and their family are able to focus on rebuilding their lives whilst we concentrate on valuing and negotiating settlement of the claim.
Compensation is carefully structured to ensure the best provision for the injured person’s needs. Our clients often benefit from different types of compensation, including:
Where healthcare is found to be (legally) negligent, then the claimant (the person making the claim) must prove that their injury was caused or significantly worsened by the negligent care.
This is important because the patient may already be very ill when they receive negligent medical care. In those circumstances, they must prove that their injury (and its financial consequences) would have been avoided or greatly reduced if correct treatment had been given. This aspect of the medical negligence claim is known as ‘causation’. Causation must be proven, even if negligence is admitted, for the claim to succeed and compensation to be awarded.
Negligence and causation must be proven by supportive opinions from medical experts. We instruct experts in the same field of medicine as the negligent care to tell us whether the care that was given was of a reasonable standard. If negligence is proven, we ask medical specialists in the type of injury suffered, to confirm whether our client’s injury was caused or made worse by the negligent treatment, or would have been reduced or avoided with correct care.
In a medical negligence claim, compensation will only be paid for injuries and loss that we can prove were caused by the healthcare provider’s negligence. Once we know what mistakes were made, the next step (causation) is to identify the extent of the injury or disability that was caused by those mistakes.
Proving causation in complex medical negligence cases requires both medical expertise and understanding of the law. We often succeed in claims where NHS Resolution (the NHS’ defence organisation) has denied ‘causation’. You can read more about how we overcome difficulties with causation in complex birth injury cases.
Our medical negligence and personal injury teams have been nationally recognised for over 20 years because of their expertise, empathy and commitment to securing maximum compensation for our clients.
Fran has been an amazing support through a very difficult time for me and my family. Always available to speak and kept me in the loop with anything happening, she has been so kind, and I thank her so much for helping and getting my mum the justice she deserved.
What has to be some of the most testing horrible times was dealt with in a dignified, honest, approachable and truly empathetic manner. I could not begin to do Susan justice for her handling of our case.
I approached Boyes Turner after my claim was turned down by one of the Medical Negligence Claim company. My wife was a victim of medical negligence.
Boyes Turner have acted so efficiently on our behalf and was able to win our case. Anytime we contact them, their customer service was very good as they kept us fully informed of every level our case has developed. They are very friendly and approachable and great in their professional advise. I would strongly recommend anyone approach them for their legal and medical negligence services.
Thoroughly professional, knowledgable and approachable with communication and updates as and when needed, in what can be a drawn out process, I was always comfortable asking questions and always received answers which were clear and understandable. Highly recommend
I came to Boyes Turner desperate after searching the web for a firm to use for my sons case. He was only a few months so my mind was all over the place, but from the very first point of contact I felt a sense of relieve and belonging. I was welcomed and looked after by amazing staff who always communicated everything so well and went the extra mile to explain things and ensure I understood what was happening every step of the way (THANK YOU SUSAN BROWN). Susan was amazing I felt like I not only had a solicitor but someone who understood my emotions as a mother and always handled me with so much compassion and that was all I needed to keep me going for the 6 years of the case. Years went by in a breeze because of how professional Boyes Turner was. I am so greatful I went through it all with them and mananged to get my son a good compensation. We look forward our new life where my sons needs are priority after struggling for so long. Thank you Boyes Turner and thank you Susan Brown. My family and I are ever indebted.