Retained Placenta and Uterine Inversion Negligence Claims

Understanding the Third Stage of Labour

To understand if your care was negligent, we must first look at what is supposed to happen. The delivery of the placenta,known as the third stage of labour,is not a passive event. It is a critical medical procedure that requires constant vigilance from your midwifery and obstetric team.

The Third Stage Explained

The third stage begins the moment your baby is born and ends only when the placenta and membranes have been completely delivered. This is widely recognised as the most dangerous time for the mother because of the risk of severe bleeding (haemorrhage).

In almost all Irish maternity hospitals, this stage is handled using a protocol called "active management." This is the standard safety approach designed to prevent blood loss. It involves three specific steps your team must follow:

• Medication (Uterotonics): You are given an injection (usually Oxytocin or Syntocinon) into your thigh or IV line. This drug forces the womb (uterus) to contract firmly, which helps peel the placenta off the uterine wall.
• Clamping and Cutting the Cord: This is done after a short delay to allow blood to flow to the baby.
• Controlled Cord Traction: This is a skilled technique. The midwife or doctor gently pulls on the umbilical cord to guide the placenta out. They must only do this when the womb is hard and contracted.

If you requested a "natural" third stage (physiological management) without drugs, the risks are slightly different, but the duty of care remains the same: the staff must monitor you closely for any sign that the placenta is not separating naturally.

What Is a Retained Placenta?

A retained placenta is a medical diagnosis made when the placenta does not come out within the standard safety limits. Under HSE guidelines, this is typically:

• 30 minutes if you had active management (the injection).
• One hour if you had a physiological (natural) third stage.

If the placenta stays inside longer than this, the risk of heavy bleeding increases rapidly. Clinically, doctors group this problem into three categories:

1. Placenta Adherens: This is the most common type. The placenta is stuck simply because the muscle of the womb hasn't squeezed hard enough to push it off the wall.
2. Trapped Placenta: Here, the placenta has successfully peeled away from the wall, but the cervix (neck of the womb) has closed shut before it could get out. The placenta is loose but physically trapped inside.
3. Abnormally Adherent Placenta (Accreta): This is a more serious structural issue. The placental tissue has grown too deeply into the muscle of the womb. It cannot separate naturally. This often requires complex surgery and, in severe cases, a hysterectomy (removal of the womb) to stop the bleeding.

Retained Placenta vs. Retained Products of Conception (RPOC)

It is very important to know the difference between these two terms, as they lead to different types of legal claims:

• Retained Placenta: This usually means the entire placenta (or a very large part of it) is still inside you immediately after the birth. It is an emergency that happens in the delivery room.
• Retained Products of Conception (RPOC): This is more subtle and often goes unnoticed at first. The main placenta is delivered, and the midwife might even say it looks fine. However, a small fragment of tissue or a piece of the membrane has broken off and been left behind. You might go home feeling okay, only to develop infection, heavy bleeding, or pain weeks later.

Note: Many negligence claims arise from RPOC because it often implies that the inspection of the placenta at birth was not done carefully enough.

Uterine Inversion: An Obstetric Emergency

Uterine inversion is a rare but terrifying emergency. It is exactly what it sounds like: the uterus turns inside out. It is a life-threatening event that requires immediate, highly skilled action from the senior doctors on duty.

What Is Uterine Inversion?

Imagine a sock being pulled inside out. During an inversion, the top of the womb (the fundus) collapses inwards. In severe cases, the womb can be pulled right down through the cervix and can even be visible outside the body.

This is a catastrophe for two reasons:

• Neurogenic Shock: The inversion pulls violently on the internal ligaments and nerves. This causes the mother to go into deep shock,her blood pressure crashes and she may collapse,often before any major bleeding starts.
• Massive Haemorrhage: Because the womb is inside out, the muscles cannot clamp down to seal the blood vessels. This leads to extremely rapid and massive blood loss.

The Link Between Uterine Inversion and Third Stage Management

While some inversions happen spontaneously due to weakness in the tissues, a significant number are caused by human error.

The most common cause of avoidable uterine inversion is excessive traction on the umbilical cord. If a doctor or midwife pulls on the cord too hard, or pulls before the placenta has separated, they can drag the fundus down with it.

To prevent this, every clinician is trained in a technique called "guarding the uterus." They must place one hand on your lower tummy to hold the womb in place while pulling the cord with the other hand. If they fail to do this, or if they pull when the womb is relaxed, they may be liable for the injury that follows.

How These Complications Should Be Managed

When we investigate a case, we are not just looking at the bad outcome; we are looking at the process. Irish hospitals have clear protocols for these emergencies. Negligence happens when staff deviate from these protocols or react too slowly.

Active Management and Monitoring

The hour after birth is often called the "golden hour." Your safety depends on the team spotting warning signs immediately.

• Medication: If the placenta is slow to come, they should give extra doses of drugs (uterotonics) to stimulate the womb.
• Vigilance: They must check your pulse and blood pressure frequently. A racing heart (tachycardia) is often the first clue that you are bleeding internally or that an inversion is starting.

Manual Removal of Placenta (MROP)

If the drugs don't work and the placenta is still inside, the standard treatment is a manual removal of placenta (MROP). This is a surgery, and it has strict rules:

• Location: It should be done in an operating theatre, not the delivery room (unless the bleeding is so fast that moving you is dangerous).
• Pain Relief: You cannot be expected to endure this without proper anaesthesia. You should have a spinal block, epidural top-up, or general anaesthetic.
• Antibiotics: Because the doctor is placing their hand inside the uterus, the risk of infection is high. You must be given antibiotics to prevent sepsis.

Verification and Documentation

This is the single most important step for preventing RPOC.

• The Inspection: The midwife or doctor must lay the placenta out on a flat surface and examine it under good light. They must check both the "baby side" and the "mother side" to ensure no pieces are missing.
• The Record: They must write in your notes that the placenta was complete. If it looks "ragged" or if a piece seems to be missing, they cannot just ignore it.
• The Action: If there is any doubt, they must explore the uterus manually or send you for an urgent ultrasound. Missing a piece of placenta is a classic error that leads to claims.

Postnatal Discharge Advice

When you are sent home, the hospital still has a duty of care. You must be given clear instructions on what is normal and what is dangerous.

You should be told that passing clots larger than a 50c coin, soaking a pad every hour, or having a fever are signs of retained tissue and that you need to come back immediately. If they fail to warn you, and you sit at home getting sicker because you think it's "normal," that failure to warn can be negligence.

Signs of Negligence

In our experience, medical negligence cases regarding the placenta usually fall into a few specific patterns. We look for these red flags when we review your file.

Missed Signs and Delayed Diagnosis

This is common in RPOC cases.

• The "Complete" Placenta: The notes say the placenta was complete, but three weeks later you pass a large piece of tissue. This suggests the initial check was incompetent.
• Dismissal: You go to the A&E or call the maternity ward complaining of pain and bleeding. Instead of bringing you in for a scan, you are told "it's just the womb shrinking" and sent away. This delay allows infection to set in.

Surgical and Procedural Errors

• The "Tug of War": In uterine inversion cases, we often see evidence that the clinician was pulling aggressively on the cord.
• Incomplete Surgery: You undergo a Manual Removal (MROP) in theatre, but the doctor fails to check the entire cavity of the womb, leaving a piece behind. This means you have to undergo a second surgery later, doubling your trauma.
• No Ultrasound: You present with bleeding weeks after birth, but the doctors assume it is just a period or minor infection. They prescribe antibiotics blindly without ordering an ultrasound to check for retained tissue.

The Consequences for the Mother

These errors are not minor. They can alter the course of a woman’s life:

• Physical: Many of our clients suffer from chronic pelvic pain, sepsis (blood poisoning), and severe anaemia that leaves them too weak to care for their newborn.
• Fertility: Repeated surgeries (D&C) can cause scarring of the womb (Asherman’s Syndrome), which can make it difficult or impossible to get pregnant again. In the worst cases, a hysterectomy is performed to save the mother's life, ending her fertility permanently.
• Psychological: The trauma of a rush to theatre, the fear of death, and the separation from the baby often lead to Post-Traumatic Stress Disorder (PTSD). This psychological injury is a valid and significant part of any legal claim.

Establishing a Medical Negligence Case in Ireland

Bringing a claim against a hospital or doctor is a serious legal process. It is not enough to show that something went wrong; we must prove that the care was legally negligent.

Substandard Care vs. Complication

We are very honest with our clients: a bad outcome is not always negligence. Sometimes, a placenta grows into the wall (accreta) and no doctor could have prevented the bleeding.

The legal test we use is strict. We must prove that no medical practitioner of equal status and skill would have acted in this way.

For example:

• If a doctor pulled the cord without guarding the uterus, that is negligence because no competent doctor would do that.
• If a doctor missed a piece of placenta that was clearly visible, that is negligence.

Time Limits

Under the Statute of Limitations, you generally have two years to start a legal case. However, the clock doesn't always start on the baby's birthday. It starts from your "date of knowledge." This is the date you first realised (or should have realised) that your injury was significant and might be the hospital's fault.

• Example: If you had a retained placenta removed 6 weeks after birth, your date of knowledge" might be the day of that diagnosis, not the day of the birth.

These rules are technically complex. We strongly advise you to contact us as soon as possible so we can protect your position.

Gathering Evidence for Your Claim

If we believe you have a case, we take on the burden of gathering evidence. However, your own records and memories are the starting point.

Maternity Records

We will request your full file from the hospital. We specifically look for:

• The Partogram: This is the timeline of your labour. It tells us exactly when the baby was born and when the placenta was delivered.
• Theatre Notes: If you had a manual removal, these notes tell us who did the surgery, what drugs were used, and if any difficulties were recorded.
• Fluid Balance Charts: These allow us to calculate exactly how much blood you lost, which is often different from the "estimated" loss written in the notes.

Postnatal and GP Records

What happened after you went home?

• GP Visits: Did you go to your doctor complaining of a smell or fever? These notes prove that you had symptoms of infection.
• Prescriptions: Records of antibiotics prove that infection was present.
• Scan Reports: The ultrasound report that confirms "echogenic material" in the womb is the "smoking gun" that proves tissue was left behind.

Your Personal Timeline

We encourage you to write down your story.

• When did the pain start?
• Who did you tell?
• What did they say? "It's normal"? "Take some paracetamol"?
• This timeline helps us show that you did everything right, but the medical team failed to listen.

How Michael Boylan LLP Can Assist

We know that contacting a solicitor can feel overwhelming. You might be worried about the cost, the stress, or the impact on the medical staff. Our goal is to remove that weight from your shoulders.

Investigating the Care Provided

We handle the entire investigation. We request the records, we sort through the paperwork, and we identify the key issues. We translate the medical jargon into plain English so you understand exactly what happened to you.

Securing Expert Opinions

We have an established network of world-class medical experts. We will find the specific expert,whether a senior midwife or a consultant obstetrician,who is best placed to comment on your case. Their opinion forms the backbone of your claim.

Providing Answers and Closure

Our clients often tell us that the most important thing is simply knowing the truth. We help you get answers. If we prove negligence, we will fight tirelessly to secure the compensation you need to pay for therapy, future surgeries, and to acknowledge the suffering you have endured.

Frequently Asked Questions

Can I claim for retained placenta if I signed a consent form?

Yes. A consent form is not a waiver for negligence. It gives the doctor permission to perform a procedure (like removing the placenta), but it requires them to do it with reasonable skill and care. If they perform it badly, the consent form does not protect them.

Is uterine inversion always the doctor's fault?

Not always, but often. While it can happen spontaneously, it is frequently caused by pulling on the cord when the uterus is relaxed. Our experts will examine the notes to see if the correct "guarding" technique was used.

How long does a retained placenta claim take in Ireland?

Every case is different, but generally, medical negligence claims take between 2 to 4 years. This depends on whether the hospital admits they were wrong or if they fight the case. We push to resolve cases as efficiently as possible.

What if my infection was treated by my GP, not the hospital?

You can still claim. If the hospital left the tissue behind, they are responsible for the infection that followed, even if your GP was the one who fixed it.

Can I claim for the psychological trauma alone?

Yes. In Ireland, you can claim for "nervous shock" or psychiatric injury (like PTSD) caused by a negligent birth, even if your physical injuries have healed. This is a very common and valid part of these claims.

Contact Us

You should not have to face the aftermath of a traumatic birth alone. If you or a loved one has suffered due to a retained placenta, uterine inversion, or postpartum haemorrhage, we are here to listen.

We offer a confidential, compassionate environment where you can discuss what happened without pressure. Let us use our expertise to get you the answers and the justice you deserve.

Contact Michael Boylan LLP today.

*In contentious business, a solicitor may not calculate fees or other charges as a percentage or proportion of any award or settlement.