Expert Witness Journal Issue 65 February 2026 - Flipbook - Page 39
…. There were no symptoms and signs of evolving
abruption… it was only at 09.05 hours when the
PG was inserted that there was vaginal bleeding” .
I do not know whether these experts actually had a
discussion or just exchanged draft written comments,
but this disconnect shows how one expert can mislead
himself by overlooking a key entry in the clinical
notes, despite it being referred to by the other expert.
Professor Thornton accepted that, by 09.25 am, the
decision to do a CS was necessary due to the visualised
blood. As for the need for continuous CTG after that
decision, Mr Mason advised it was necessary but
Professor Thornton completely avoided answering the
question of whether it should have been reconnected.”
Agrawal had postulated that the insult occurred
between 0944 and 1009 with 10 minutes recovery
before delivery at 1019 and that this would explain
why the Claimant was not in a worse condition at
delivery. However the Judge found:
“
and
“
When challenged on his opinion about 08.48 am,
he accepted that he had overlooked the entry at
08.35 am stating fresh blood on M’s pad and 昀氀ushed
away in the toilet. He accepted that her account was
consistent with a signi昀椀cant fresh bleed in hospital. I
was unimpressed by his answers about the decisions
made by Mr Siddig at 08.48 am. He criticised Mr
Siddig for diagnosing a local cause for bleeding
without examination, but would not accept that the
08.35 am note of fresh blood on the pad and down the
toilet was “signi昀椀cant” enough to mandate immediate
examination and a CS. He accepted that the daytime
CTG was very unusual due to the spikey baseline
variability and the baseline rising steadily from 105
to 160 bpm and the decelerations.”
The Judge summarised his 昀椀ndings in respect of
breach of duty by the obstetrician as follows:
“
As for the obstetric management at 08.48 am, I
accept the evidence of both expert obstetricians that
Mr Siddig was in breach of his duty of care when
diagnosing a local cause for the bleeding. He did not
even try to visualise the suspect ectropian. I also 昀椀nd
that he negligently overlooked the note, made a mere
13 minutes before his ward round, setting out that
fresh blood was seen on M’s pad and M’s report that
she saw fresh blood in the toilet. I 昀椀nd that Mr Siddig
should have examined M at that time and would
probably have seen fresh blood in her vagina. That,
combined with the odd trace, starting with a low
baseline of 105 bpm (normal 110-160 bpm), the spikey
variability and the lack of any accelerations, should
have led to a decision for a CS. I accept Mr Mason’s
opinion that, at that time, the working diagnosis
should have been a suspected PA. As a result, I
昀椀nd that a CS was mandated. Professor Thornton
never really addressed the whole of the facts at this
timepoint and carelessly ignored the fresh bleed report
at 08.35 am so I do not 昀椀nd his opinion helpful on
this timepoint.”
Attractively argued though Doctor Agrawal’s theory
was, there were various fault lines within it. Firstly,
the sheep experiments did not support the level of
recovery in C’s levels of acidosis, from a very severe
brain injury, to his condition at birth, in a mere 3-10
minutes (or indeed the 14 minutes maximum which I
calculated above). I do place a little weight on those
because they are the only review papers available and
they were not criticised for their methodology, only for
having small samples. Secondly, the other experts did
not accept that recovery in that very short space of time
was likely from their clinical experience. Thirdly, the
08.30 am CTG started with a baseline at 105 bpm,
which is below normal, leading slowly up to 140-160
bpm. I accept Mr Mason’s evidence that this might
indicate a post injury recovery process. Fourthly, the
Agrawal hypothesis rests on cord compression and
so on M staying still for 25 minutes causing that
compression. But, on his theory, this stillness was
happening at a time whilst she was being prepared
for theatre, then transported from her room to theatre,
then being consented and prepared for the spinal
anaesthetic. The entry in midwife Rogers’ notes on the
start of the operation was: “knife to skin 10-”, in which
case she must have had the spinal before then and
been bent over for the needle insertion. That would
have involved quite substantial body movement,
potentially interrupting any cord compression.
Whereas the nighttime compression would probably
have occurred when M was asleep. Fifthly, I consider
that Janet Rennie’s approach was thoughtful and
analytical. I prefer her evidence to that of Doctor
Agrawal on the timing of the hypoxic insult. I also
prefer the evidence of Mr Mason and Doctor Thomas
on the timing of the insult.”
and
“
For the above reasons, I 昀椀nd that C su昀昀ered an APHI,
lasting 20-25 minutes, before 08.30 am and probably
at the later end of the period 05.15 – 07.50 am. It
However whilst the Claimant was able to establish
breach of duty at 0848 the claim failed as the
Claimant could not establish the insult would have
been avoided by earlier delivery after 0848. Dr
EXPERT WITNESS JOURNAL
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FEBRUARY 2026
